Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | ME 102105 | FL |
NPI | 1528281409 |
---|---|
Provider Name | Ivan Alberto Gonzalez |
First Address | Miami, FL 33136 |
Second Address | Miami, FL 33136 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 12/08/2008 |