Provider Demographics
NPI:1447564828
Name:ROSA GONZALEZ, GLENDA DENISSE (MD)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:DENISSE
Last Name:ROSA GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GLENDA
Other - Middle Name:
Other - Last Name:ROSA GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:999 S VOLUSIA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-6564
Mailing Address - Country:US
Mailing Address - Phone:386-917-7681
Mailing Address - Fax:386-774-2561
Practice Address - Street 1:999 S VOLUSIA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-6564
Practice Address - Country:US
Practice Address - Phone:386-917-7681
Practice Address - Fax:386-774-2561
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20660207R00000X, 208M00000X
FLME139894207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist