Provider Demographics
NPI:1598994055
Name:GONZALEZ, VIMAYLA E (M D)
Entity Type:Individual
Prefix:
First Name:VIMAYLA
Middle Name:E
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3190 CITRUS TOWER BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6886
Mailing Address - Country:US
Mailing Address - Phone:352-242-2282
Mailing Address - Fax:352-242-2886
Practice Address - Street 1:3190 CITRUS TOWER BLVD STE B
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6886
Practice Address - Country:US
Practice Address - Phone:352-242-2282
Practice Address - Fax:352-242-2886
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME118365207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1598994055OtherNPI