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General NPI Number Information
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NPI Number | 1306614920
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Entity Type | Individual
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Provider Name | GONZALO PORTAL LEMOCK APRN
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Gender | Male
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Dates
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Enumeration Date | 12/13/2023
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 18300 NW 62ND AVE STE 210
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City | MIAMI GARDENS
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State | FL
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Zip | 33015-8207
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Country | US
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Telephone | 786-677-9922
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Fax | 844-895-3066
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Provider Business Mailing Address
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Address Line | 18300 NW 62ND AVE STE 210
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City | MIAMI GARDENS
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State | FL
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Zip | 33015-8207
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Country | US
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Telephone | 786-677-9922
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Fax | 844-895-3066
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11030115
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License Number State | FL
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