Provider Demographics
NPI:1942352729
Name:GONZALEZ-OLIVARES, MENAYRA C (MD)
Entity Type:Individual
Prefix:DR
First Name:MENAYRA
Middle Name:C
Last Name:GONZALEZ-OLIVARES
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 1:4482 FOXTAIL LN
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3847
Mailing Address - Country:US
Mailing Address - Phone:954-217-0144
Mailing Address - Fax:305-217-0144
Practice Address - Street 1:710 ALTON RD
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-5504
Practice Address - Country:US
Practice Address - Phone:305-538-8835
Practice Address - Fax:305-532-5766
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66671208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377017600Medicaid
FL377017600Medicaid