Basic Information
| Provider Information | |||||||||
| NPI: | 1275836330 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MARISELA GONZALEZ M.D.P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2780 SW 87TH AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331653296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052203700 | ||||||||
| FaxNumber: | 3052209002 | ||||||||
| Practice Location | |||||||||
| Address1: | 2780 SW 87TH AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331653296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052203700 | ||||||||
| FaxNumber: | 3052209002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2010 | ||||||||
| LastUpdateDate: | 12/13/2010 | ||||||||
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| AuthorizedOfficialLastName: | GONZALEZ | ||||||||
| AuthorizedOfficialFirstName: | MARISELA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/SOLE PROPRIETOR | ||||||||
| AuthorizedOfficialTelephone: | 3052203700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | ME59833 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.