Healthcare Provider Details

I. General information

NPI: 1467108597
Provider Name (Legal Business Name): LUIS GONZALEZ OTERO APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E 25TH ST STE 212
HIALEAH FL
33013-3850
US

IV. Provider business mailing address

222 NW 71ST AVE
MIAMI FL
33126-4363
US

V. Phone/Fax

Practice location:
  • Phone: 786-409-7329
  • Fax: 786-409-7330
Mailing address:
  • Phone: 786-923-6523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11009691
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: