Healthcare Provider Details

I. General information

NPI: 1265642581
Provider Name (Legal Business Name): FANNY GONZALEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FANNY GONZALEZ M.D.

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 SW 3RD AVE UNIT CU-1
MIAMI FL
33129-2056
US

IV. Provider business mailing address

PO BOX 144653
CORAL GABLES FL
33114-4653
US

V. Phone/Fax

Practice location:
  • Phone: 305-856-7005
  • Fax: 305-856-7533
Mailing address:
  • Phone: 305-867-7005
  • Fax: 305-856-7533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME106001
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberME106001
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: