Provider Demographics
NPI:1750945911
Name:GONZALEZ, ELSA CRISTINA (MD)
Entity type:Individual
Prefix:
First Name:ELSA
Middle Name:CRISTINA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 FAIRLAKE TRCE APT 2210
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2849
Mailing Address - Country:US
Mailing Address - Phone:954-487-9373
Mailing Address - Fax:
Practice Address - Street 1:2225 N COMMERCE PKWY STE 6
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3240
Practice Address - Country:US
Practice Address - Phone:954-487-9373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2019-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health