Healthcare Provider Details

I. General information

NPI: 1699115741
Provider Name (Legal Business Name): MONICA GONZALEZ VIGON D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9971 W FLAGLER ST SUITE 220
MIAMI FL
33174-1810
US

IV. Provider business mailing address

13912 SW 25TH ST
MIAMI FL
33175-7051
US

V. Phone/Fax

Practice location:
  • Phone: 786-418-3074
  • Fax:
Mailing address:
  • Phone: 786-488-0856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN20163
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: