Basic Information
| Provider Information | |||||||||
| NPI: | 1285604322 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALEZ PEREZ | ||||||||
| FirstName: | MIGUEL | ||||||||
| MiddleName: | ANGEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12171 SW 268TH ST | ||||||||
| Address2: | |||||||||
| City: | HOMESTEAD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330328001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052780200 | ||||||||
| FaxNumber: | 3058514110 | ||||||||
| Practice Location | |||||||||
| Address1: | 3342 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | RIVIERA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334042328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612494409 | ||||||||
| FaxNumber: | 5619092071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2006 | ||||||||
| LastUpdateDate: | 11/15/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 15000 | PR | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | ACN-837 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.