Provider Demographics
NPI:1144547399
Name:FANNY GONZALEZ, M.D. P.A.
Entity type:Organization
Organization Name:FANNY GONZALEZ, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-856-7005
Mailing Address - Street 1:PO BOX 144653
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33114-4653
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2525 SW 3RD AVE
Practice Address - Street 2:UNIT CU1
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33129-2056
Practice Address - Country:US
Practice Address - Phone:305-856-7005
Practice Address - Fax:305-856-7533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1060012080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric NephrologyGroup - Single Specialty