Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | APRN11003429 | FL |
NPI | 1003459025 |
---|---|
Provider Name | Ivon Gonzalez |
First Address | Miramar, FL 33025-2734 |
Second Address | Miramar, FL 33025-2734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2019 |
Last Update Date | 22/10/2019 |