Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 15837 | PR |
NPI | 1114070570 |
---|---|
Provider Name | Juan Jose Gonzalez |
First Address | Clermont, FL 34711-1968 |
Second Address | Orlando, FL 32826-4743 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 09/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I-71448 | (02) | PR |