Provider Demographics
NPI:1285422147
Name:GONZALEZ GONZALEZ, FERNANDO ANDRES
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:ANDRES
Last Name:GONZALEZ GONZALEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1394 DUNLAWTON AVE APT 503
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4761
Mailing Address - Country:US
Mailing Address - Phone:787-420-8048
Mailing Address - Fax:
Practice Address - Street 1:1394 DUNLAWTON AVE APT 503
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4761
Practice Address - Country:US
Practice Address - Phone:787-420-8048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH15460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor