Provider Demographics
NPI:1487496451
Name:GONZALEZ, JOEL D (PA-C)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:D
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 W 68TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1801
Mailing Address - Country:US
Mailing Address - Phone:786-860-6004
Mailing Address - Fax:305-441-9342
Practice Address - Street 1:7100 W 20TH AVE STE G176
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1875
Practice Address - Country:US
Practice Address - Phone:786-475-1985
Practice Address - Fax:786-475-2854
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9119315363AS0400X
VA0110010579363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical