Provider Demographics
NPI:1700538576
Name:GONZALEZ CAMEJO, RUBEN EVARISTO
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:EVARISTO
Last Name:GONZALEZ CAMEJO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 JOHNSON ST APT 109
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-3960
Mailing Address - Country:US
Mailing Address - Phone:305-748-3016
Mailing Address - Fax:
Practice Address - Street 1:2249 JOHNSON ST UNIT 109
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-3912
Practice Address - Country:US
Practice Address - Phone:305-748-3016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant