1366638546 NPI number — MR. FRANCISCO GONZALEZ PA

Table of content: MR. FRANCISCO GONZALEZ PA (NPI 1366638546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366638546 NPI number — MR. FRANCISCO GONZALEZ PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ
Provider First Name:
FRANCISCO
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GONZALEZ
Provider Other First Name:
FRANCISCO
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1366638546
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1002 S. DILLARD STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER GARDEN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-877-3577
Provider Business Mailing Address Fax Number:
407-877-8495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1002 S DILLARD ST STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTER GARDEN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34787-3991
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-877-3577
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  9100627 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 169181 . This is a "FELLOW SHIP IN PROGRESS METABOLIC AND NUTRITIONAL MEDICINE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 04166641 . This is a "EDUCATIONAL COMMISSION FOR FOREIGN MEDICAL GRADUATE CERTIFICATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 539442194 . This is a "AMERICAN DIABETES ASSOCIATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: ME26402800100 . This is a "AMA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 9100627 . This is a "PA, LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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