MEDICARE: SANDY GONZALEZ LAMAR

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	363LF0000X	Family Nurse Practitioner	675030	FL
2	363LF0000X	Family Nurse Practitioner	11035160	FL

General Provider Information

NPI Number	:	1538994520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDY GONZALEZ LAMAR

Provider Business Mailing Address
First Line	:	8428 NW 103RD ST APT 106
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-4675
Country	:	US
Telephone Number	:	786-314-4043
Fax Number	:

Provider Business Practice Location Address
First Line	:	8428 NW 103RD ST APT 106
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-4675
Country	:	US
Telephone Number	:	786-314-4043
Fax Number	:

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

Provider Enumeration Date	:	09/07/2024
Last Update Date	:	09/10/2024

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