Provider Demographics
NPI:1932810546
Name:DR G FAMILY - MEDICAL AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:DR G FAMILY - MEDICAL AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-930-8001
Mailing Address - Street 1:14522 LANDSTAR BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-6450
Mailing Address - Country:US
Mailing Address - Phone:497-930-8001
Mailing Address - Fax:
Practice Address - Street 1:14522 LANDSTAR BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-6450
Practice Address - Country:US
Practice Address - Phone:497-930-8001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty