Healthcare Provider Details

I. General information

NPI: 1437984804
Provider Name (Legal Business Name): RAUL ROSBEL GONZALEZ APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 NW 51ST TER
MIAMI FL
33142-3772
US

IV. Provider business mailing address

2015 NW 51ST TER
MIAMI FL
33142-3772
US

V. Phone/Fax

Practice location:
  • Phone: 305-975-1320
  • Fax:
Mailing address:
  • Phone: 305-975-1320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11034943
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: