Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME123682 | FL |
NPI | 1033418546 |
---|---|
Provider Name | Annie Gonzalez |
First Address | Fort Myers, FL 33908-5182 |
Second Address | Miami, FL 33133-4221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2011 |
Last Update Date | 22/05/2019 |