Provider Demographics
NPI:1871780130
Name:ORTHOPAEDIC CENTER OF VENICE PL
Entity type:Organization
Organization Name:ORTHOPAEDIC CENTER OF VENICE PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:9414-853-3302
Mailing Address - Street 1:241 NOKOMIS AVE S
Mailing Address - Street 2:SUITE B
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2319
Mailing Address - Country:US
Mailing Address - Phone:941-485-3302
Mailing Address - Fax:941-485-2673
Practice Address - Street 1:241 NOKOMIS AVE S
Practice Address - Street 2:SUITE B
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2319
Practice Address - Country:US
Practice Address - Phone:941-485-3302
Practice Address - Fax:941-485-2673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61283207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35812OtherBCBS
FLDB6741OtherRAILROAD MEDICARE
FL5379810001Medicare NSC
FL35812OtherBCBS
H18715Medicare UPIN