Provider Demographics
NPI:1629793641
Name:GONZALEZ SANCHEZ, EDWIN JOSE (FNP)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:JOSE
Last Name:GONZALEZ SANCHEZ
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 STANTON DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3591
Mailing Address - Country:US
Mailing Address - Phone:786-760-1130
Mailing Address - Fax:
Practice Address - Street 1:17110 ROYAL PALM BLVD STE 3
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-2309
Practice Address - Country:US
Practice Address - Phone:786-760-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11022371207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology