Healthcare Provider Details

I. General information

NPI: 1144858416
Provider Name (Legal Business Name): DIAN BUENO GONZALEZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 BLANDING BLVD STE 1
MIDDLEBURG FL
32068-3839
US

IV. Provider business mailing address

705 WELLS RD STE 300
ORANGE PARK FL
32073-2982
US

V. Phone/Fax

Practice location:
  • Phone: 904-406-3160
  • Fax: 833-578-1800
Mailing address:
  • Phone: 904-282-6331
  • Fax: 904-866-4818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberOS22665
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: