Healthcare Provider Details

I. General information

NPI: 1992269922
Provider Name (Legal Business Name): CRISTINA ALEJANDRA GONZALEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRISTINA ALEJANDRA GOMEZ

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W FAIRBANKS AVE STE 100
WINTER PARK FL
32789-4777
US

IV. Provider business mailing address

1111 W FAIRBANKS AVE STE 100
WINTER PARK FL
32789-4777
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-1869
  • Fax: 321-843-6285
Mailing address:
  • Phone: 321-841-1869
  • Fax: 321-843-6285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA911901
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9111901
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9111901
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: