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General NPI Number Information
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NPI Number | 1295793628
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Entity Type | Individual
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Provider Name | LUIS A GONZALEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 270 N SYKES CREEK PKWY UNIT 108
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City | MERRITT ISLAND
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State | FL
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Zip | 32953
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Country | US
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Telephone | 321-452-1061
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Fax | 321-453-0866
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Provider Business Mailing Address
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Address Line | PO BOX 541216
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City | MERRITT ISLAND
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State | FL
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Zip | 32954-1216
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Country | US
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Telephone | 321-450-1061
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Fax | 321-453-0866
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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 | ME60685
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License Number State | FL
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