Provider Demographics
NPI:1649766197
Name:GONZALEZ, DEMYS D
Entity Type:Individual
Prefix:
First Name:DEMYS
Middle Name:D
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 SW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7408
Mailing Address - Country:US
Mailing Address - Phone:305-546-3036
Mailing Address - Fax:
Practice Address - Street 1:6705 SW 57TH AVE STE 522
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143
Practice Address - Country:US
Practice Address - Phone:786-517-8650
Practice Address - Fax:786-517-8657
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9379228363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health