MEDICARE: DR. MARIA GONZALEZ OD,PA

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	152W00000X	Optometrist	OP2796	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	:	1356323810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA GONZALEZ OD,PA

Provider Business Mailing Address
First Line	:	2264 CORAL WAY
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33145-3509
Country	:	US
Telephone Number	:	305-854-0736
Fax Number	:	305-490-0754

Provider Business Practice Location Address
First Line	:	2264 CORAL WAY
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33145-3509
Country	:	US
Telephone Number	:	305-854-0736
Fax Number	:	305-490-0754

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	08/03/2012

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