Basic Information
| Provider Information | |||||||||
| NPI: | 1639165319 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15680 N KENDALL DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331961159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054369933 | ||||||||
| FaxNumber: | 3054369944 | ||||||||
| Practice Location | |||||||||
| Address1: | 1150 CAMPO SANO AVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331461174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057797381 | ||||||||
| FaxNumber: | 3057797382 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2005 | ||||||||
| LastUpdateDate: | 03/15/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | ME67735 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 263175000 | 05 | FL | MEDICAID |