Healthcare Provider Details

I. General information

NPI: 1184687329
Provider Name (Legal Business Name): EFRAIN H GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11020 SW 88TH ST STE 102C
MIAMI FL
33176
US

IV. Provider business mailing address

11020 SW 88TH ST STE 102C
MIAMI FL
33176-1217
US

V. Phone/Fax

Practice location:
  • Phone: 786-703-6120
  • Fax: 786-703-6108
Mailing address:
  • Phone: 786-703-6120
  • Fax: 786-703-6108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME 57627
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME57627
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: