Healthcare Provider Details

I. General information

NPI: 1942900196
Provider Name (Legal Business Name): EDILBERTO GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8992 NW 174TH ST
HIALEAH FL
33018-6661
US

IV. Provider business mailing address

8992 NW 174TH ST
HIALEAH FL
33018-6661
US

V. Phone/Fax

Practice location:
  • Phone: 786-788-2297
  • Fax:
Mailing address:
  • Phone: 786-788-2297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11024984
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4042553
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number710139
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: