Provider Demographics
NPI:1104028497
Name:GONZALEZ, RICHARD (CST/CSFA, RNFA, CNOR)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:CST/CSFA, RNFA, CNOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 WHITE TOWER WAY
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-7294
Mailing Address - Country:US
Mailing Address - Phone:813-817-9969
Mailing Address - Fax:
Practice Address - Street 1:3100 E FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4613
Practice Address - Country:US
Practice Address - Phone:813-817-9969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO103780246ZC0007X
FL103780246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other