Provider Demographics
NPI:1356323810
Name:GONZALEZ, MARIA (OD,PA)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:OD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2264 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3509
Mailing Address - Country:US
Mailing Address - Phone:305-854-0736
Mailing Address - Fax:305-490-0754
Practice Address - Street 1:2264 CORAL WAY
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-3509
Practice Address - Country:US
Practice Address - Phone:305-854-0736
Practice Address - Fax:305-490-0754
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP2796152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620085100Medicaid
FL20533Medicare ID - Type Unspecified