Healthcare Provider Details

I. General information

NPI: 1720720261
Provider Name (Legal Business Name): GERARDO AGUILERA GONZALEZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3157 N UNIVERSITY DR STE 103
HOLLYWOOD FL
33024-2258
US

IV. Provider business mailing address

3157 N UNIVERSITY DR STE 103
HOLLYWOOD FL
33024-2258
US

V. Phone/Fax

Practice location:
  • Phone: 954-758-4127
  • Fax: 954-405-8794
Mailing address:
  • Phone: 954-758-4127
  • Fax: 954-405-8794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS20678
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS20678
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: