Provider Demographics
NPI:1649484122
Name:QUESADA, GONZALO FABIO (MD)
Entity type:Individual
Prefix:
First Name:GONZALO
Middle Name:FABIO
Last Name:QUESADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 S DIXIE HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2456
Mailing Address - Country:US
Mailing Address - Phone:305-285-8900
Mailing Address - Fax:305-285-1462
Practice Address - Street 1:3414 W 84TH ST STE 100
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4932
Practice Address - Country:US
Practice Address - Phone:786-313-3558
Practice Address - Fax:786-360-5803
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME841852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry