Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | ME0052209 | FL |
NPI | 1063436004 |
---|---|
Provider Name | Dr. Susana Gonzalez |
First Address | Miami Beach, FL 33139-3809 |
Second Address | Miami Beach, FL 33139-3809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 06/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
048427000 | (05) | FL |
08213 | BLUE CROSS BLUE SHIELD (01) | FL |
D92867 | (02) | FL |