Organization Name: | JOSE A GONZALEZ |
NPI Number: | 1013336478 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOSE A GONZALEZ (OWNER) |
Mailing Address: | 1340 W 68th St Hialeah |
State: | FL US |
Postal Code: | 330144526 |
Phone Number: | 3055567245 |
Fax Number: | 3055589426 |
NPI Enumeration Date: | 04/14/2014 |
NPI Last Update Date: | 04/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ME0055443 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |