Provider Demographics
NPI:1437920949
Name:GONZALEZ, SANDRA (DO)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 SR 60 EAST
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33898
Mailing Address - Country:US
Mailing Address - Phone:863-679-1915
Mailing Address - Fax:863-679-1634
Practice Address - Street 1:2000 SR 60 EAST
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33898
Practice Address - Country:US
Practice Address - Phone:863-679-1915
Practice Address - Fax:863-679-1634
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO7156156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician