Provider Demographics
NPI:1457839987
Name:GONZALEZ ALVAREZ, EUSEBIO DE JESUS (FNP)
Entity Type:Individual
Prefix:
First Name:EUSEBIO
Middle Name:DE JESUS
Last Name:GONZALEZ ALVAREZ
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14036 SW 90TH AVE APT AA101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7143
Mailing Address - Country:US
Mailing Address - Phone:786-344-7187
Mailing Address - Fax:
Practice Address - Street 1:14036 SW 90TH AVE APT AA101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7143
Practice Address - Country:US
Practice Address - Phone:786-344-7187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9439986363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily