=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376505982
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EFRAIN H GONZALEZ MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2006
-----------------------------------------------------
Last Update Date | 06/12/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11020 SW 88TH ST STE 102C
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-596-3649
-----------------------------------------------------
Fax | 305-596-0878
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11020 SW 88TH ST STE 102C
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176-1217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-596-3649
-----------------------------------------------------
Fax | 305-596-0878
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | EFRAIN H GONZALEZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 786-703-6120
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | ME 57627
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------