Healthcare Provider Details

I. General information

NPI: 1447224472
Provider Name (Legal Business Name): FAUSTINO GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 EAST AVE
WEST PALM BEACH FL
33407-2387
US

IV. Provider business mailing address

5300 EAST AVE
WEST PALM BEACH FL
33407-2387
US

V. Phone/Fax

Practice location:
  • Phone: 561-227-5270
  • Fax: 561-863-2806
Mailing address:
  • Phone: 561-227-5270
  • Fax: 561-863-2806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME49456
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME49456
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: