Healthcare Provider Details

I. General information

NPI: 1871780130
Provider Name (Legal Business Name): ORTHOPAEDIC CENTER OF VENICE PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 NOKOMIS AVE S SUITE B
VENICE FL
34285-2319
US

IV. Provider business mailing address

241 NOKOMIS AVE S SUITE B
VENICE FL
34285-2319
US

V. Phone/Fax

Practice location:
  • Phone: 941-485-3302
  • Fax: 941-485-2673
Mailing address:
  • Phone: 941-485-3302
  • Fax: 941-485-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME61283
License Number StateFL

VIII. Authorized Official

Name: DR. JULIO GONZALEZ
Title or Position: OWNER
Credential: M.D.
Phone: 94148533302