Provider Demographics
NPI:1952418980
Name:ALLERGY ASTHMA & SINUS CENTER
Entity Type:Organization
Organization Name:ALLERGY ASTHMA & SINUS CENTER
Other - Org Name:GABRIEL GONZALEZ
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-790-2258
Mailing Address - Street 1:12959 PALMS WEST DRIVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470
Mailing Address - Country:US
Mailing Address - Phone:561-790-2258
Mailing Address - Fax:561-791-7489
Practice Address - Street 1:12959 PALMS WEST DRIVE
Practice Address - Street 2:SUITE 230
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470
Practice Address - Country:US
Practice Address - Phone:561-790-2258
Practice Address - Fax:561-791-7489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050008207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4218Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER