Provider Demographics
NPI:1083465066
Name:GONZALEZ MAURA, ORLANDO
Entity Type:Individual
Prefix:
First Name:ORLANDO
Middle Name:
Last Name:GONZALEZ MAURA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8835 NW 116TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1929
Mailing Address - Country:US
Mailing Address - Phone:786-334-2629
Mailing Address - Fax:
Practice Address - Street 1:801 NW 37TH AVE STE 212
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3883
Practice Address - Country:US
Practice Address - Phone:305-504-6131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11032002363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily