Provider Demographics
NPI:1720010317
Name:GONZALEZ, SANDINO A (MD)
Entity Type:Individual
Prefix:
First Name:SANDINO
Middle Name:A
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 SUNSET DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5040
Mailing Address - Country:US
Mailing Address - Phone:305-274-9890
Mailing Address - Fax:305-661-2794
Practice Address - Street 1:6150 SUNSET DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5040
Practice Address - Country:US
Practice Address - Phone:305-274-9890
Practice Address - Fax:305-661-2794
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME75564207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG64087Medicare UPIN