Provider Demographics
NPI:1740214337
Name:GONZALEZ ABREU AND FERNANDEZ MD PA
Entity Type:Organization
Organization Name:GONZALEZ ABREU AND FERNANDEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:JESUS
Authorized Official - Last Name:ABREU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-822-8229
Mailing Address - Street 1:7150 W 20 AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5509
Mailing Address - Country:US
Mailing Address - Phone:305-822-8229
Mailing Address - Fax:305-826-5805
Practice Address - Street 1:7150 W 20 AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5509
Practice Address - Country:US
Practice Address - Phone:305-822-8229
Practice Address - Fax:305-826-5805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38207OtherBLUE CROSS BLUE SHIELD
FL255758400Medicaid
FL38207Medicare ID - Type Unspecified