Healthcare Provider Details

I. General information

NPI: 1871581249
Provider Name (Legal Business Name): RAQUEL M GONZALEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5385 NE 2ND AVE
MIAMI FL
33137-2707
US

IV. Provider business mailing address

5801 MIAMI LAKES DR E
MIAMI LAKES FL
33014-2401
US

V. Phone/Fax

Practice location:
  • Phone: 305-756-9977
  • Fax: 305-756-5757
Mailing address:
  • Phone: 305-821-9115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0060686
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: