Individual provider Active NPI

Edwin Jose Gonzalez Sanchez, FNP

  • Dermatology Physician
  • Weston, FL
National Provider Identifier
1629793641
Registry record updated Oct 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
11022371 Issued in FL
Practice address
17110 Royal Palm Blvd Ste 3
Weston, FL 33326-2309
Phone
(786) 760-1130
NPI assigned
Oct 12, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 12, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 11022371 FL Primary

Addresses

Primary practice location

17110 Royal Palm Blvd Ste 3
Weston, FL 33326-2309

Mailing address

650 Stanton Dr
Weston, FL 33326-3591
Phone (786) 760-1130

Other practice location 1

6705 S Red Rd Ste 612
South Miami, FL 33143-3649
Phone (786) 760-1130

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

LicenseStateTypeSpecialty
11022371FLMDDermatology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1665532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665532800000",
    "number": "1629793641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 STANTON DR",
            "city": "WESTON",
            "state": "FL",
            "postal_code": "333263591",
            "telephone_number": "786-760-1130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17110 ROYAL PALM BLVD STE 3",
            "city": "WESTON",
            "state": "FL",
            "postal_code": "333262309",
            "telephone_number": "786-760-1130"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6705 S Red Rd Ste 612",
            "address_purpose": "LOCATION",
            "city": "South Miami",
            "state": "FL",
            "postal_code": "331433649",
            "country_code": "US",
            "telephone_number": "786-760-1130",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GONZALEZ SANCHEZ",
        "first_name": "EDWIN",
        "middle_name": "JOSE",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-10-12",
        "last_updated": "2022-10-12",
        "certification_date": "2022-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "11022371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Weston, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.