Basic Information
| Provider Information | |||||||||
| NPI: | 1285732164 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DE QUESADA | ||||||||
| FirstName: | GONZALO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | SOUTH DADE NEONATOLOGY | ||||||||
| Address2: | 215 GRAND AVENUE | ||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331334841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054417179 | ||||||||
| FaxNumber: | 3054487134 | ||||||||
| Practice Location | |||||||||
| Address1: | SOUTH DADE NEONATOLOGY | ||||||||
| Address2: | 215 GRAND AVENUE | ||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331334841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054417179 | ||||||||
| FaxNumber: | 3054487134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 08/22/2018 | ||||||||
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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 | 208000000X | ME 13221 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 049834300 | 05 | FL | MEDICAID |