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General NPI Number Information
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NPI Number | 1932455904
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Entity Type | Organization
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Legal Business Name | MISAEL GONZALEZ MD P A
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Dates
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Enumeration Date | 07/27/2012
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Last Update Date | 10/21/2013
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Provider Practice Location Address
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Address Line | 760 PONCE DE LEON BLVD STE 107A
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City | CORAL GABLES
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State | FL
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Zip | 33134-2076
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Country | US
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Telephone | 305-967-8311
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Fax | 305-967-8506
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Provider Business Mailing Address
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Address Line | 760 PONCE DE LEON BLVD, SUITE 107A
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City | CORAL GABLES
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State | FL
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Zip | 33134-2076
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Country | US
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Telephone | 305-967-8311
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Fax | 305-967-8506
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MISAEL GONZALEZ
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Credential | MD
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Telephone | 305-967-8311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME80610
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License Number State | FL
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