Provider Demographics
NPI:1669446480
Name:VALDIVIA, GONZALO G (MD)
Entity Type:Individual
Prefix:DR
First Name:GONZALO
Middle Name:G
Last Name:VALDIVIA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:650 S COURTENAY PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-4977
Mailing Address - Country:US
Mailing Address - Phone:321-394-2660
Mailing Address - Fax:321-394-2669
Practice Address - Street 1:1421 MALABAR RD NE
Practice Address - Street 2:STE 200
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2576
Practice Address - Country:US
Practice Address - Phone:321-308-2660
Practice Address - Fax:321-984-9303
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2022-08-19
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Provider Licenses
StateLicense IDTaxonomies
FLME81813207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00037101OtherMEDICARE RAILROAD
FL114495500Medicaid
FLH74433Medicare UPIN