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General NPI Number Information
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NPI Number | 1578759197
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Entity Type | Individual
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Provider Name | NELSON GONZALEZ MD
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Gender | Male
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | 11045 SW 216 ST
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City | MIAMI
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State | FL
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Zip | 33170
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Country | US
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Telephone | 786-429-1639
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Fax | 786-883-0900
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Provider Business Mailing Address
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Address Line | 15753 SW 140TH ST
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City | MIAMI
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State | FL
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Zip | 33196-6714
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Country | US
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Telephone | 305-431-6957
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME101417
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | ME101417
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License Number State | FL
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