MEDICARE: MS. XIOMARA GONZALEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171WV0202X	Vehicle Modifications Contractor		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063048635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. XIOMARA GONZALEZ

Provider Business Mailing Address
First Line	:	3026 HANGING ROCK CT E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-3815
Country	:	US
Telephone Number	:	904-420-8881
Fax Number	:

Provider Business Practice Location Address
First Line	:	3026 HANGING ROCK CT E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-3815
Country	:	US
Telephone Number	:	904-420-8881
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2020
Last Update Date	:	03/16/2020

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Directions to “ MS. XIOMARA GONZALEZ ” Practice Location

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