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General NPI Number Information
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NPI Number | 1083872725
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Entity Type | Organization
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Legal Business Name | HORACIO GONZALEZ MD PA
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 09/11/2008
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Provider Practice Location Address
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Address Line | 515 STATE ROAD 436 SUITE 1006
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City | CASSELBERRY
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State | FL
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Zip | 32707-5341
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Country | US
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Telephone | 407-834-3730
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Fax | 407-834-4863
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Provider Business Mailing Address
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Address Line | 515 STATE ROAD 436 SUITE 1006
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City | CASSELBERRY
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State | FL
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Zip | 32707-5341
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Country | US
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Telephone | 407-834-3730
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Fax | 407-834-4863
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Authorized Official
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Title or Position | OWNER
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Name | DR. HORACIO GONZALEZ
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Credential | M.D
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Telephone | 407-834-3730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME41239
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License Number State | FL
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