Healthcare Provider Details

I. General information

NPI: 1942442538
Provider Name (Legal Business Name): JUAN MANUEL GONZALEZ HERRAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6975 TAFT ST
HOLLYWOOD FL
33024-3801
US

IV. Provider business mailing address

2000 PALM BEACH LAKES BLVD STE 901
WEST PALM BEACH FL
33409-6506
US

V. Phone/Fax

Practice location:
  • Phone: 954-466-0003
  • Fax:
Mailing address:
  • Phone: 561-509-5009
  • Fax: 844-612-3977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number239550
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME162348
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: