Healthcare Provider Details

I. General information

NPI: 1750563243
Provider Name (Legal Business Name): MERCEDES E GONZALEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 NW 14TH ST FL 2
MIAMI FL
33136-2137
US

IV. Provider business mailing address

1150 NW 14TH ST FL 2
MIAMI FL
33136-2137
US

V. Phone/Fax

Practice location:
  • Phone: 917-309-3214
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberME99998
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME99998
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: