Provider Demographics
NPI:1568802080
Name:GONZALEZ RODRIGUEZ, LIRKA
Entity Type:Individual
Prefix:
First Name:LIRKA
Middle Name:
Last Name:GONZALEZ RODRIGUEZ
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 1:3302 BONITA BEACH RD STE 170
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-4217
Mailing Address - Country:US
Mailing Address - Phone:239-624-1050
Mailing Address - Fax:239-624-1051
Practice Address - Street 1:3302 BONITA BEACH RD STE 170
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4217
Practice Address - Country:US
Practice Address - Phone:239-624-1050
Practice Address - Fax:239-624-1051
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME127374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y0NQPOtherBCBS