Provider Demographics
NPI:1942971494
Name:GONZALEZ, PEDRO JUAN (CST)
Entity Type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:JUAN
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 ARMED FORCES RESERVE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-5226
Mailing Address - Country:US
Mailing Address - Phone:910-771-8975
Mailing Address - Fax:
Practice Address - Street 1:9500 ARMED FORCES RESERVE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-5226
Practice Address - Country:US
Practice Address - Phone:910-771-8975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians