Provider Demographics
NPI:1700980398
Name:GONZALEZ, MIRTHA FERNANDA (DO)
Entity Type:Individual
Prefix:MS
First Name:MIRTHA
Middle Name:FERNANDA
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 1:1840 W 49TH ST
Mailing Address - Street 2:STE. 220-11
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2942
Mailing Address - Country:US
Mailing Address - Phone:305-819-8116
Mailing Address - Fax:305-819-8116
Practice Address - Street 1:1840 W 49TH ST
Practice Address - Street 2:STE. 220-11
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2942
Practice Address - Country:US
Practice Address - Phone:305-819-8116
Practice Address - Fax:305-819-8116
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO5159156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician