Provider Demographics
NPI:1457693566
Name:GONZALEZ, RIQUEL (DPM)
Entity Type:Individual
Prefix:
First Name:RIQUEL
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4999 W 8TH AVE STE 22
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3409
Mailing Address - Country:US
Mailing Address - Phone:786-536-4542
Mailing Address - Fax:786-536-4484
Practice Address - Street 1:4999 W 8TH AVE STE 22
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3409
Practice Address - Country:US
Practice Address - Phone:786-536-4542
Practice Address - Fax:786-536-4484
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3603213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery