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General NPI Number Information
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NPI Number | 1265642581
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Entity Type | Individual
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Provider Name | FANNY GONZALEZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 2525 SW 3RD AVE UNIT CU-1
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City | MIAMI
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State | FL
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Zip | 33129-2056
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Country | US
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Telephone | 305-856-7005
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Fax | 305-856-7533
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Provider Business Mailing Address
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Address Line | PO BOX 144653
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City | CORAL GABLES
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State | FL
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Zip | 33114-4653
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Country | US
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Telephone | 305-867-7005
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Fax | 305-856-7533
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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 | ME106001
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2080P0210X
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Taxonomy Name | Pediatric Nephrology Physician
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License Number | ME106001
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License Number State | FL
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