Provider Demographics
NPI:1992752372
Name:GONZALEZ PERALTA, REGINO P (MD)
Entity type:Individual
Prefix:DR
First Name:REGINO
Middle Name:P
Last Name:GONZALEZ PERALTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:REGINO
Other - Middle Name:P
Other - Last Name:GONZALEZ PERALTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:615 E PRINCETON ST STE 401
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1469
Mailing Address - Country:US
Mailing Address - Phone:407-303-9311
Mailing Address - Fax:407-303-9273
Practice Address - Street 1:615 E PRINCETON ST STE 401
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1469
Practice Address - Country:US
Practice Address - Phone:407-303-9311
Practice Address - Fax:407-303-9273
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME568902080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052915000Medicaid
FL68557ZMedicare PIN
FLE81519Medicare UPIN