Healthcare Provider Details

I. General information

NPI: 1700779873
Provider Name (Legal Business Name): MIGUEL GONZALEZ CAA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR
MIAMI FL
33176-2197
US

IV. Provider business mailing address

19836 SW 122ND AVE
MIAMI FL
33177-4904
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-3621
  • Fax:
Mailing address:
  • Phone: 305-510-3341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA1077
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: