Provider Demographics
NPI:1689880031
Name:ESTEVEZ DEL CRISTO, GONZALO (MD)
Entity type:Individual
Prefix:MR
First Name:GONZALO
Middle Name:
Last Name:ESTEVEZ DEL CRISTO
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 1:44 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4842
Mailing Address - Country:US
Mailing Address - Phone:305-888-9786
Mailing Address - Fax:305-888-8243
Practice Address - Street 1:44 E 5TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4842
Practice Address - Country:US
Practice Address - Phone:305-888-9786
Practice Address - Fax:305-888-8243
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0022726207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054201600Medicaid
FL78051Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO.