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General NPI Number Information
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NPI Number | 1619360716
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Entity Type | Individual
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Provider Name | ERNESTO GONZALEZ DIAZ
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Gender | Male
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Dates
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Enumeration Date | 03/13/2015
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 701 N FEDERAL HWY STE 210
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-2451
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Country | US
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Telephone | 954-998-2099
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Fax |
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Provider Business Mailing Address
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Address Line | 107 SARTO AVE
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City | CORAL GABLES
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State | FL
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Zip | 33134-7247
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Country | US
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Telephone | 786-317-3321
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 23004
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License Number State | FL
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