Provider Demographics
NPI:1104539121
Name:GONZALEZ, DIANE LOO (APRN)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:LOO
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 CORAL WAY APT 114
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3185
Mailing Address - Country:US
Mailing Address - Phone:305-975-5670
Mailing Address - Fax:
Practice Address - Street 1:3232 CORAL WAY APT 114
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-3185
Practice Address - Country:US
Practice Address - Phone:305-975-5670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11022468207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty