MEDICARE: LAURA 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	2084P0800X	Psychiatry Physician	ME164211	FL

General Provider Information

NPI Number	:	1356908867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA GONZALEZ MD

Provider Business Mailing Address
First Line	:	3236 N POINCIANA BLVD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-4688
Country	:	US
Telephone Number	:	407-262-2220
Fax Number	:	407-834-5011

Provider Business Practice Location Address
First Line	:	3236 N POINCIANA BLVD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-4688
Country	:	US
Telephone Number	:	407-262-2220
Fax Number	:	407-834-5011

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

Provider Enumeration Date	:	05/21/2019
Last Update Date	:	08/25/2025

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