Provider Demographics
NPI:1871897009
Name:GONZALEZ, ANCIZAR (PA)
Entity type:Individual
Prefix:
First Name:ANCIZAR
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5975 SUNSET DR STE 402
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5198
Mailing Address - Country:US
Mailing Address - Phone:305-669-2833
Mailing Address - Fax:305-669-2840
Practice Address - Street 1:1600 NE 1ST AVE APT 3220
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-1280
Practice Address - Country:US
Practice Address - Phone:561-281-8132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAT9105709363A00000X
FLPA9106499363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant