Healthcare Provider Details

I. General information

NPI: 1477295541
Provider Name (Legal Business Name): ARIEL GONZALES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2022
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3448 NW 79TH ST
MIAMI FL
33147-4602
US

IV. Provider business mailing address

9725 NW 117TH AVE FL 2
MEDLEY FL
33178-1212
US

V. Phone/Fax

Practice location:
  • Phone: 786-949-6347
  • Fax: 866-285-7068
Mailing address:
  • Phone: 954-432-0578
  • Fax: 954-432-5060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME176065
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101286577
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: