Provider Demographics
NPI:1730105602
Name:GONZALEZ, BLANCA ELENA (MD)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:ELENA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE # R3
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-636-1077
Mailing Address - Fax:213-636-3405
Practice Address - Street 1:9500 EUCLID AVE # R-3
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-8000
Practice Address - Country:US
Practice Address - Phone:216-636-1077
Practice Address - Fax:216-636-3405
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0940482080P0208X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025903660001Medicaid
OH2998743Medicaid
FL275594700Medicaid
PA1025903660001Medicaid
OH2998743Medicaid