Basic Information
| Provider Information | |||||||||
| NPI: | 1912987983 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | CHRISTIAN | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 223190 | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330223190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059745533 | ||||||||
| FaxNumber: | 3059745553 | ||||||||
| Practice Location | |||||||||
| Address1: | 21000 NE 28TH AVE STE 104 | ||||||||
| Address2: | |||||||||
| City: | AVENTURA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331801421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059745533 | ||||||||
| FaxNumber: | 3059745553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 08/06/2019 | ||||||||
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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 | 207L00000X | 106959 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 106959 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.