Healthcare Provider Details

I. General information

NPI: 1396151809
Provider Name (Legal Business Name): SUSANA GONZALEZ, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 ALTON ROAD
MIAMI BEACH FL
33139
US

IV. Provider business mailing address

1225 ALTON ROAD
MIAMI BEACH FL
33139
US

V. Phone/Fax

Practice location:
  • Phone: 305-532-8355
  • Fax: 305-532-9675
Mailing address:
  • Phone: 305-532-8355
  • Fax: 305-532-9675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME0052209
License Number StateFL

VIII. Authorized Official

Name: MRS. ESTHER ENCINOSA
Title or Position: DIRECTOR
Credential:
Phone: 305-532-8355