Healthcare Provider Details

I. General information

NPI: 1376505982
Provider Name (Legal Business Name): EFRAIN H GONZALEZ MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
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: 305-596-3649
  • Fax: 305-596-0878
Mailing address:
  • Phone: 305-596-3649
  • Fax: 305-596-0878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME 57627
License Number StateFL

VIII. Authorized Official

Name: EFRAIN H GONZALEZ
Title or Position: OWNER
Credential: M.D.
Phone: 786-703-6120