Healthcare Provider Details

I. General information

NPI: 1598750341
Provider Name (Legal Business Name): SANDRA M GONZALEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA M GONZALEZ-MONTALVO MD

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

IV. Provider business mailing address

10865 SW 153RD AVE
MIAMI FL
33196-3571
US

V. Phone/Fax

Practice location:
  • Phone: 305-666-6511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberME60524
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME60524
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: