MEDICARE: VIVIANNE GONZALEZ DO

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	207R00000X	Internal Medicine Physician	9896	FL

General Provider Information

NPI Number	:	1104357078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIANNE GONZALEZ DO

Provider Business Mailing Address
First Line	:	2001 W 68TH ST, SUITE 202
Second Line	:	MEDICAL EDUCATION DEPARTMENT
City	:	HIALEAH
State	:	FL
Zip	:	33016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 W 68TH ST STE 202
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-1898
Country	:	US
Telephone Number	:	305-822-8347
Fax Number	:

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

Provider Enumeration Date	:	03/23/2017
Last Update Date	:	06/11/2024

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