Provider Demographics
NPI:1073843991
Name:ESTRELLA GONZALEZ, CARLOS ALEXIS (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ALEXIS
Last Name:ESTRELLA GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 OAKLEY SEAVER DR STE C
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1925
Mailing Address - Country:US
Mailing Address - Phone:352-242-1021
Mailing Address - Fax:352-242-1104
Practice Address - Street 1:1804 OAKLEY SEAVER DR STE C
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1925
Practice Address - Country:US
Practice Address - Phone:352-242-1021
Practice Address - Fax:352-242-1104
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105963208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty