1003601782 NPI number — DR. LUIS ALFONSO GONZALEZ MIRANDA MD, MPH

Table of content: DR. LUIS ALFONSO GONZALEZ MIRANDA MD, MPH (NPI 1003601782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003601782 NPI number — DR. LUIS ALFONSO GONZALEZ MIRANDA MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ MIRANDA
Provider First Name:
LUIS
Provider Middle Name:
ALFONSO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003601782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
GME ADMIN
Provider Second Line Business Mailing Address:
1200 EAST BROAD STREET, BOX 980257
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23298
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-828-9331
Provider Business Mailing Address Fax Number:
804-806-7587

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 E LEIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23298-5004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-828-9331
Provider Business Practice Location Address Fax Number:
804-806-7587
Provider Enumeration Date:
04/12/2025

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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