Healthcare Provider Details

I. General information

NPI: 1265740898
Provider Name (Legal Business Name): LUIS F GONZALEZ-PRENDES R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WATERMAN ST
DETROIT MI
48209-2022
US

IV. Provider business mailing address

34400 W 14 MILE RD
WEST BLOOMFIELD MI
48322-3322
US

V. Phone/Fax

Practice location:
  • Phone: 313-841-8900
  • Fax:
Mailing address:
  • Phone: 248-661-2551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704210894
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: