Provider Demographics
NPI:1801932314
Name:WELLINGTON MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:WELLINGTON MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-791-7969
Mailing Address - Street 1:12953 PALMS WEST DR STE 202
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4992
Mailing Address - Country:US
Mailing Address - Phone:561-791-7969
Mailing Address - Fax:561-791-7968
Practice Address - Street 1:12953 PALMS WEST DR STE 202
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4992
Practice Address - Country:US
Practice Address - Phone:561-791-7969
Practice Address - Fax:561-791-7968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI20424Medicare UPIN