Provider Demographics
NPI:1679810642
Name:GONZALEZ, FABIO ANDRES (RPH)
Entity Type:Individual
Prefix:
First Name:FABIO
Middle Name:ANDRES
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10755 NW 58TH ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2801
Mailing Address - Country:US
Mailing Address - Phone:305-597-1529
Mailing Address - Fax:305-597-3742
Practice Address - Street 1:10755 NW 58TH ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2801
Practice Address - Country:US
Practice Address - Phone:305-597-1529
Practice Address - Fax:305-597-3742
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45424183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist