Provider Demographics
NPI:1114104296
Name:GONZALEZ-MATOS, CLAUDIA BEATRICE (MD)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:BEATRICE
Last Name:GONZALEZ-MATOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:800-480-5243
Mailing Address - Fax:
Practice Address - Street 1:7578 SE MARICAMP RD STE 113
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-4275
Practice Address - Country:US
Practice Address - Phone:352-577-9879
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16922208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN692OtherMEDICAL LICENSE
FL015755700Medicaid