Provider Demographics
NPI:1316185309
Name:GONZALEZ CARRILLO, ROYNEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROYNEL
Middle Name:
Last Name:GONZALEZ CARRILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROYNEL
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:801 S DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-1355
Mailing Address - Country:US
Mailing Address - Phone:954-985-1470
Mailing Address - Fax:
Practice Address - Street 1:801 S DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-1355
Practice Address - Country:US
Practice Address - Phone:954-985-1470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108237207P00000X, 207Q00000X
IL125-055087390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program