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NPI Code Detail

MEDICARE: MR. SANDRA GONZALEZ MD

MEDICARE: MR. SANDRA 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
12084P0800XPsychiatry PhysicianME0079036FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13159OTHERFLBCBSFL
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1992747919
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SANDRA GONZALEZ MD
Provider Business Mailing Address
First Line : 400 E SHERIDAN RD
Second Line :
City : MELBOURNE
State : FL
Zip : 32901-3122
Country : US
Telephone Number : 321-634-6264
Fax Number :
Provider Business Practice Location Address
First Line : 400 E SHERIDAN RD
Second Line :
City : MELBOURNE
State : FL
Zip : 32901-3122
Country : US
Telephone Number : 321-634-6264
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 11/03/2011

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