Provider Demographics
NPI:1497292874
Name:GONZALEZ PAIN CENTER INC
Entity Type:Organization
Organization Name:GONZALEZ PAIN CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-381-5550
Mailing Address - Street 1:4800 W FLAGLER ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1446
Mailing Address - Country:US
Mailing Address - Phone:305-381-5550
Mailing Address - Fax:305-646-1984
Practice Address - Street 1:4800 W FLAGLER ST
Practice Address - Street 2:SUITE 212
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1446
Practice Address - Country:US
Practice Address - Phone:305-381-5550
Practice Address - Fax:305-646-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty