Provider Demographics
NPI:1356543201
Name:GONZALEZ, ELIZABETH (DO)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14601 SW 29TH ST
Mailing Address - Street 2:SUITE# 303
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4712
Mailing Address - Country:US
Mailing Address - Phone:954-332-9972
Mailing Address - Fax:
Practice Address - Street 1:14601 SW 29TH ST
Practice Address - Street 2:SUITE# 303
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4712
Practice Address - Country:US
Practice Address - Phone:954-332-9972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 10599207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004013500Medicaid