Active NPI
Lisdan Gonzalez Sr.
- Massage Therapist
- Miami, FL
National Provider Identifier
1356808497
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- HCC11651
- Practice address
- 777 NW 72ND Ave Ste 3072
Miami, FL 33126-3188 - Phone
- (305) 396-3862
- Fax
- (305) 396-8526
- NPI assigned
- Feb 25, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | HCC11651 | FL | |
| Massage Therapist | 225700000X | HCC11651 | FL | Primary |
Addresses
Primary practice location
777 NW 72ND Ave Ste 3072
Miami, FL 33126-3188
Mailing address
777 NW 72ND Ave Ste 3072
Miami, FL 33126-3188
Phone (305) 396-3862
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| HCC11651 | FL | MD | Physical Medicine & Rehabilitation Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551052800000",
"number": "1356808497",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "777 NW 72ND AVE STE 3072",
"city": "MIAMI",
"state": "FL",
"postal_code": "331263188",
"telephone_number": "305-396-3862",
"fax_number": "305-396-8526"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "777 NW 72ND AVE STE 3072",
"city": "MIAMI",
"state": "FL",
"postal_code": "331263188",
"telephone_number": "305-396-3862",
"fax_number": "305-396-8526"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALEZ",
"first_name": "LISDAN",
"name_suffix": "Sr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-02-25",
"last_updated": "2019-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "FL",
"license": "HCC11651",
"primary": false
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "FL",
"license": "HCC11651",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Miami, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.