Provider Demographics
NPI:1124094339
Name:GONZALEZ-ABELLO, LISA MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIA
Last Name:GONZALEZ-ABELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:615-778-8537
Mailing Address - Fax:615-628-6877
Practice Address - Street 1:2200 RINGLING BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237
Practice Address - Country:US
Practice Address - Phone:941-861-2710
Practice Address - Fax:941-861-2708
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071260208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253370700Medicaid
E6890ZMedicare ID - Type Unspecified
FL253370700Medicaid