Provider Demographics
NPI:1922578392
Name:GONZALEZ, GUIDO
Entity Type:Individual
Prefix:
First Name:GUIDO
Middle Name:
Last Name:GONZALEZ
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 1:16881 SW 146TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-2039
Mailing Address - Country:US
Mailing Address - Phone:786-344-3145
Mailing Address - Fax:
Practice Address - Street 1:1435 W 49TH PL STE 201
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3147
Practice Address - Country:US
Practice Address - Phone:305-828-4155
Practice Address - Fax:305-828-9339
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000314363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily