Basic Information
| Provider Information | |||||||||
| NPI: | 1952418980 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLERGY ASTHMA & SINUS CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GABRIEL GONZALEZ | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12959 PALMS WEST DRIVE | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | LOXAHATCHEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617902258 | ||||||||
| FaxNumber: | 5617917489 | ||||||||
| Practice Location | |||||||||
| Address1: | 12959 PALMS WEST DRIVE | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | LOXAHATCHEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617902258 | ||||||||
| FaxNumber: | 5617917489 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 09/07/2010 | ||||||||
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| AuthorizedOfficialLastName: | GONZALEZ | ||||||||
| AuthorizedOfficialFirstName: | GABRIEL | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5617902258 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207KA0200X | ME0050008 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology | Allergy |
No ID Information.