Provider Demographics
NPI:1679927693
Name:GONZALEZ'S CAFE
Entity type:Organization
Organization Name:GONZALEZ'S CAFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT
Authorized Official - Phone:786-316-3253
Mailing Address - Street 1:935 W 49TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3436
Mailing Address - Country:US
Mailing Address - Phone:305-818-1099
Mailing Address - Fax:
Practice Address - Street 1:8050 NW 103RD ST
Practice Address - Street 2:SUITE 103
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-2252
Practice Address - Country:US
Practice Address - Phone:786-316-3253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSEA2313433332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals