Provider Demographics
NPI:1174906861
Name:GONZALEZ, SAUL NICOLAS (MD)
Entity type:Individual
Prefix:
First Name:SAUL
Middle Name:NICOLAS
Last Name:GONZALEZ
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 1:10360 NW 76TH TER
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4076
Mailing Address - Country:US
Mailing Address - Phone:787-467-6746
Mailing Address - Fax:
Practice Address - Street 1:12905 SW 42ND ST STE 213
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-2912
Practice Address - Country:US
Practice Address - Phone:786-507-8830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR31606R390200000X
FLME137201207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program