Provider Demographics
NPI:1417180159
Name:GONZALEZ BALLAGAS, ALEJANDRO RAMON (DPM)
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:RAMON
Last Name:GONZALEZ BALLAGAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14332 NW 87TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33018-8044
Mailing Address - Country:US
Mailing Address - Phone:786-630-0330
Mailing Address - Fax:
Practice Address - Street 1:3410 W 84TH ST STE 100
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4906
Practice Address - Country:US
Practice Address - Phone:305-826-7774
Practice Address - Fax:305-826-5505
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3777213E00000X
FLPO3777213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery