Healthcare Provider Details

I. General information

NPI: 1154257418
Provider Name (Legal Business Name): DANIELA MARIA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4719 N OCEAN DR
LAUDERDALE BY THE SEA FL
33308-2914
US

IV. Provider business mailing address

8131 SW 5TH ST
NORTH LAUDERDALE FL
33068-2004
US

V. Phone/Fax

Practice location:
  • Phone: 954-488-3636
  • Fax:
Mailing address:
  • Phone: 954-297-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN31881
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: