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General NPI Number Information
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NPI Number | 1053487603
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Entity Type | Individual
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Provider Name | ALFREDO V GONZALES M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1701S.E. HILLMOOR DR. SUITE #4
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City | PORT ST. LUCIE
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State | FL
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Zip | 34952
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Country | US
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Telephone | 772-335-5656
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 SE HILLMOOR DR SUITE #4
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7552
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Country | US
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Telephone | 772-335-5656
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME30145
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License Number State | FL
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