Provider Demographics
NPI:1245339837
Name:WELLINGTON MEDICAL CARE ASSOCIATES
Entity type:Organization
Organization Name:WELLINGTON MEDICAL CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN MANAGE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-791-7969
Mailing Address - Street 1:1460 ROYAL PALM BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1608
Mailing Address - Country:US
Mailing Address - Phone:561-791-7969
Mailing Address - Fax:561-791-7968
Practice Address - Street 1:1460 ROYAL PALM BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1608
Practice Address - Country:US
Practice Address - Phone:561-791-7969
Practice Address - Fax:561-791-7968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL98783OtherFLORIDA BLUE
FL013694600Medicaid