MEDICARE: GRACIELA VERDECIA GONZALEZ MD

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	208D00000X	General Practice Physician	ACN1456	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	:	1336815976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACIELA VERDECIA GONZALEZ MD

Provider Business Mailing Address
First Line	:	8261 NW 8TH ST APT 429
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3965
Country	:	US
Telephone Number	:	786-286-3358
Fax Number	:

Provider Business Practice Location Address
First Line	:	5378 W 16TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-2165
Country	:	US
Telephone Number	:	305-820-4101
Fax Number	:	305-820-2885

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

Provider Enumeration Date	:	08/23/2021
Last Update Date	:	08/08/2024

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