Provider Demographics
NPI:1972580322
Name:GONZALEZ, FRANCELIS IVETTE (MD)
Entity Type:Individual
Prefix:
First Name:FRANCELIS
Middle Name:IVETTE
Last Name:GONZALEZ
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 1:1050 WEST CARROLL STREET
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-1268
Mailing Address - Country:US
Mailing Address - Phone:407-518-0078
Mailing Address - Fax:407-518-0094
Practice Address - Street 1:1050 WEST CARROLL STREET
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-1268
Practice Address - Country:US
Practice Address - Phone:407-518-0078
Practice Address - Fax:407-518-0094
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-0074421208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG16493Medicare UPIN