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General NPI Number Information
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NPI Number | 1174729420
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Entity Type | Individual
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Provider Name | MICHELLE GONZALEZ O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 03/22/2021
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Provider Practice Location Address
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Address Line | 1 S.W. 129TH AVE STE 209
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City | PEMBROKE PINES
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State | FL
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Zip | 33027
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Country | US
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Telephone | 954-437-9300
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Fax | 954-437-9377
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Provider Business Mailing Address
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Address Line | P.O. BOX 39209
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City | FT. LAUDERDALE
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State | FL
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Zip | 33339
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Country | US
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Telephone | 954-851-9966
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Fax | 954-318-7360
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC3797
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License Number State | FL
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