Provider Demographics
NPI:1578181673
Name:GONZALEZ PEREZ, ALEJANDRO LAZARO (APRN)
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:LAZARO
Last Name:GONZALEZ PEREZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 NW 112TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-2240
Mailing Address - Country:US
Mailing Address - Phone:786-253-4679
Mailing Address - Fax:
Practice Address - Street 1:12024 SW 77TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-3764
Practice Address - Country:US
Practice Address - Phone:786-253-4679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11025422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily