MEDICARE: RAQUEL M GONZALEZ M.D.

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	208000000X	Pediatrics Physician	ME0060686	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	:	1871581249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAQUEL M GONZALEZ M.D.

Provider Business Mailing Address
First Line	:	5801 MIAMI LAKES DR E
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2401
Country	:	US
Telephone Number	:	305-821-9115
Fax Number	:

Provider Business Practice Location Address
First Line	:	5385 NE 2ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33137-2707
Country	:	US
Telephone Number	:	305-756-9977
Fax Number	:	305-756-5757

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

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	08/18/2016

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