Healthcare Provider Details

I. General information

NPI: 1801039938
Provider Name (Legal Business Name): PEDRO GONZALEZ PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 04/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1259 BLUEBIRD AVE
MIAMI SPRINGS FL
33166-3117
US

IV. Provider business mailing address

1259 BLUEBIRD AVE
MIAMI SPRINGS FL
33166-3117
US

V. Phone/Fax

Practice location:
  • Phone: 305-275-7029
  • Fax: 305-275-7066
Mailing address:
  • Phone: 305-275-7029
  • Fax: 305-275-7066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberPA9100617
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: