Provider Demographics
NPI:1417904715
Name:GONZALEZ, ADA (MD)
Entity Type:Individual
Prefix:DR
First Name:ADA
Middle Name:
Last Name:GONZALEZ
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 1:3191 CORAL WAY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3213
Mailing Address - Country:US
Mailing Address - Phone:305-461-6060
Mailing Address - Fax:
Practice Address - Street 1:3191 CORAL WAY
Practice Address - Street 2:SUITE 303
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-3213
Practice Address - Country:US
Practice Address - Phone:305-461-6060
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0054083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0054083OtherMEDICAL LICENSE
FLME0054083OtherMEDICAL LICENSE
FLE97760Medicare UPIN
FLBG1582229OtherDEA