Provider Demographics
NPI:1295228658
Name:GONZALEZ CABEZAS, JUAN JOSE (ARNP)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:JOSE
Last Name:GONZALEZ CABEZAS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8850 SW 123RD CT APT H205
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1963
Mailing Address - Country:US
Mailing Address - Phone:786-619-5153
Mailing Address - Fax:
Practice Address - Street 1:11255 SW 211TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33189-2240
Practice Address - Country:US
Practice Address - Phone:786-430-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9360425363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health