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General NPI Number Information
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NPI Number | 1598750341
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Entity Type | Individual
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Provider Name | SANDRA M GONZALEZ MD
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Gender | Female
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 3100 SW 62ND AVE
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City | MIAMI
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State | FL
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Zip | 33155-3009
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Country | US
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Telephone | 305-666-6511
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Fax |
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Provider Business Mailing Address
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Address Line | 10865 SW 153RD AVE
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City | MIAMI
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State | FL
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Zip | 33196-3571
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Country | US
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Telephone |
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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 | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | ME60524
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME60524
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License Number State | FL
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