Healthcare Provider Details

I. General information

NPI: 1467089730
Provider Name (Legal Business Name): ALBERT DAVID GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 WESTHALL LN STE 4
MAITLAND FL
32751-7102
US

IV. Provider business mailing address

2600 WESTHALL LN STE 4
MAITLAND FL
32751-7102
US

V. Phone/Fax

Practice location:
  • Phone: 407-200-2355
  • Fax:
Mailing address:
  • Phone: 407-200-2355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME179728
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number94301
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: