Provider Demographics
NPI:1497860969
Name:GONZALEZ-MOREJON, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:GONZALEZ-MOREJON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 N FEDERAL HWY
Mailing Address - Street 2:PATHOLOGY DEPT.
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4603
Mailing Address - Country:US
Mailing Address - Phone:954-492-5728
Mailing Address - Fax:954-776-3235
Practice Address - Street 1:4725 N FEDERAL HWY
Practice Address - Street 2:PATHOLOGY DEPT.
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4603
Practice Address - Country:US
Practice Address - Phone:954-492-5728
Practice Address - Fax:954-776-3235
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70805207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250239900Medicaid
FL31488Medicare ID - Type Unspecified
FL250239900Medicaid