Healthcare Provider Details

I. General information

NPI: 1801732060
Provider Name (Legal Business Name): FERNANDO CELSO GONZALEZ RODRIGUEZ P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 SW 11TH ST
MIAMI FL
33135-4708
US

IV. Provider business mailing address

3040 SW 11TH ST
MIAMI FL
33135-4708
US

V. Phone/Fax

Practice location:
  • Phone: 305-502-7061
  • Fax:
Mailing address:
  • Phone: 305-502-7061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3047
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3047
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number26-220
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3047
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: