Provider Demographics
NPI:1518283092
Name:GONZALEZ, RUDYARD (FMD)
Entity Type:Individual
Prefix:
First Name:RUDYARD
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:FMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8785 SW 165TH AVE STE 202A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5828
Mailing Address - Country:US
Mailing Address - Phone:786-484-7701
Mailing Address - Fax:786-513-2488
Practice Address - Street 1:8785 SW 165TH AVE STE 202A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5828
Practice Address - Country:US
Practice Address - Phone:786-484-7701
Practice Address - Fax:786-513-2488
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker