Healthcare Provider Details

I. General information

NPI: 1952212409
Provider Name (Legal Business Name): JAVIER GONZALEZ PUIG CPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8551 ANDALOMA ST
JACKSONVILLE FL
32211-5012
US

IV. Provider business mailing address

8551 ANDALOMA ST
JACKSONVILLE FL
32211-5012
US

V. Phone/Fax

Practice location:
  • Phone: 904-469-8869
  • Fax:
Mailing address:
  • Phone: 904-469-8869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberNPCN-17887-20329
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: