Provider Demographics
NPI:1942431119
Name:GONZALO QUESADA, MD, PA
Entity Type:Organization
Organization Name:GONZALO QUESADA, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GONZALO
Authorized Official - Middle Name:F
Authorized Official - Last Name:QUESADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-285-8900
Mailing Address - Street 1:2000 S DIXIE HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2456
Mailing Address - Country:US
Mailing Address - Phone:305-285-8900
Mailing Address - Fax:305-285-1462
Practice Address - Street 1:2000 S DIXIE HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2456
Practice Address - Country:US
Practice Address - Phone:305-285-8900
Practice Address - Fax:305-285-1462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84185174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279286900Medicaid
FLH77990Medicare UPIN