Healthcare Provider Details

I. General information

NPI: 1710972328
Provider Name (Legal Business Name): RUBEN GONZALEZ-PEREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date: 03/23/2006
Reactivation Date: 04/12/2006

III. Provider practice location address

11780 SW 89TH ST 3RD FLOOR
MIAMI FL
33186-2181
US

IV. Provider business mailing address

11780 SW 89TH ST 3RD FLOOR
MIAMI FL
33186-2181
US

V. Phone/Fax

Practice location:
  • Phone: 305-260-9803
  • Fax: 305-260-9298
Mailing address:
  • Phone: 305-260-9803
  • Fax: 305-260-9298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME42929
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME42929
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: