Provider Demographics
NPI:1851879175
Name:GONZALEZ LEMES, GUILLERMO BUENAVENTURA
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:BUENAVENTURA
Last Name:GONZALEZ LEMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5246 ROBBIE CT
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-9108
Mailing Address - Country:US
Mailing Address - Phone:561-729-1148
Mailing Address - Fax:
Practice Address - Street 1:7820 N ARMENIA AVE STE C
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-3852
Practice Address - Country:US
Practice Address - Phone:954-514-9360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9414641363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty