Provider Demographics
NPI:1841761624
Name:MILAN GONZALEZ, ENRIQUE (C-SA)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:MILAN GONZALEZ
Suffix:
Gender:M
Credentials:C-SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9452 NW 120TH ST APT 522
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4010
Mailing Address - Country:US
Mailing Address - Phone:786-804-7349
Mailing Address - Fax:
Practice Address - Street 1:9452 NW 120TH ST APT 522
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4010
Practice Address - Country:US
Practice Address - Phone:786-804-7349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14-485246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant