Basic Information
| Provider Information | |||||||||
| NPI: | 1982334447 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALEZ BARRERA | ||||||||
| FirstName: | HUGOLINO | ||||||||
| MiddleName: | LUIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15777 SW 74TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331933318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7866816942 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13195 SW 134TH ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331864585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7869772599 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2022 | ||||||||
| LastUpdateDate: | 06/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
No ID Information.