Provider Demographics
NPI:1386142578
Name:GONZALEZ, ALFONSO (HIS BC)
Entity type:Individual
Prefix:
First Name:ALFONSO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:HIS BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20802 BISCAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1443
Mailing Address - Country:US
Mailing Address - Phone:305-944-0242
Mailing Address - Fax:786-428-0450
Practice Address - Street 1:20802 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1443
Practice Address - Country:US
Practice Address - Phone:305-944-0242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS2696237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG524009551810OtherFLORIDA DRIVERS LICENSE