Provider Demographics
NPI:1215176300
Name:EGONZ CORP
Entity type:Organization
Organization Name:EGONZ CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-234-0509
Mailing Address - Street 1:14359 MIRAMAR PKWY
Mailing Address - Street 2:SUITE 332
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4134
Mailing Address - Country:US
Mailing Address - Phone:305-529-4964
Mailing Address - Fax:954-212-0233
Practice Address - Street 1:14359 MIRAMAR PKWY
Practice Address - Street 2:SUITE 332
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4134
Practice Address - Country:US
Practice Address - Phone:305-529-4964
Practice Address - Fax:954-212-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty