Provider Demographics
NPI:1598087280
Name:GONZALEZ, BLANCA N (MD)
Entity Type:Individual
Prefix:DR
First Name:BLANCA
Middle Name:N
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1435 W 49TH PL STE 701
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3158
Mailing Address - Country:US
Mailing Address - Phone:786-218-7863
Mailing Address - Fax:866-557-6953
Practice Address - Street 1:1435 W 49TH PL STE 701
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3158
Practice Address - Country:US
Practice Address - Phone:786-218-7863
Practice Address - Fax:866-557-6953
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME106369207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine