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General NPI Number Information
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NPI Number | 1174076194
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Entity Type | Individual
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Provider Name | RICARDO GONZALEZ
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Gender | Male
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Dates
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Enumeration Date | 07/26/2016
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Last Update Date | 07/26/2016
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Provider Practice Location Address
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Address Line | 4720 NW 167TH ST
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City | MIAMI LAKES
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State | FL
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Zip | 33014-6427
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Country | US
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Telephone | 305-454-1900
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Fax | 305-713-1200
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Provider Business Mailing Address
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Address Line | 4720 NW 167TH ST
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City | MIAMI LAKES
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State | FL
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Zip | 33014-6427
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Country | US
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Telephone | 305-454-1900
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Fax | 305-713-1200
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number | SEA2332781
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License Number State | FL
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