Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME106001 | FL |
Y | 2080P0210X | Pediatric Nephrologist | ME106001 | FL |
NPI | 1265642581 |
---|---|
Provider Name | Fanny Gonzalez |
First Address | Coral Gables, FL 33114-4653 |
Second Address | Miami, FL 33129-2056 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 25/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002182200 | (05) | FL |