Provider Demographics
NPI:1528109857
Name:GONZALEZ-GARCIA, RODOLFO (MD)
Entity type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:
Last Name:GONZALEZ-GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 SW 24TH ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2076
Mailing Address - Country:US
Mailing Address - Phone:305-220-0084
Mailing Address - Fax:305-220-0085
Practice Address - Street 1:9100 SW 24TH ST
Practice Address - Street 2:SUITE 7
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2076
Practice Address - Country:US
Practice Address - Phone:305-220-0084
Practice Address - Fax:305-220-0085
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058938100Medicaid
FL260832046OtherEID
FLBS765OtherPTAN
FLBS765OtherPTAN
FL058938100Medicaid
FL04999ZMedicare PIN