Provider Demographics
NPI:1336815976
Name:VERDECIA GONZALEZ, GRACIELA (MD)
Entity Type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:VERDECIA 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 1:1115 SE 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33035-2029
Mailing Address - Country:US
Mailing Address - Phone:786-286-3358
Mailing Address - Fax:
Practice Address - Street 1:7000 W 12TH AVE STE 21
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-5170
Practice Address - Country:US
Practice Address - Phone:305-362-9560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1456208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice