Provider Demographics
NPI:1568809325
Name:CHRISTIAN GONZALEZ, MD, LLC
Entity Type:Organization
Organization Name:CHRISTIAN GONZALEZ, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-974-5533
Mailing Address - Street 1:PO BOX 223190
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33022-3190
Mailing Address - Country:US
Mailing Address - Phone:305-974-5533
Mailing Address - Fax:305-974-5553
Practice Address - Street 1:21097 NE 27TH CT STE 320
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1206
Practice Address - Country:US
Practice Address - Phone:305-974-5533
Practice Address - Fax:305-974-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2024-01-25
Deactivation Date:2023-05-04
Deactivation Code:
Reactivation Date:2023-05-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1912987983OtherPERSONAL NPI