MEDICARE: VICTOR 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11035171	FL

General Provider Information

NPI Number	:	1083076905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR GONZALEZ

Provider Business Mailing Address
First Line	:	1901 W FLAGLER ST STE 7
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-1677
Country	:	US
Telephone Number	:	786-963-9144
Fax Number	:

Provider Business Practice Location Address
First Line	:	1901 W FLAGLER ST STE 7
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-1677
Country	:	US
Telephone Number	:	786-963-9144
Fax Number	:

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

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	10/15/2024

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Directions to “ VICTOR GONZALEZ ” Practice Location

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