# GONZALO J IRAVEDRA PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215941596
- **Authorized official:** GONZALO J IRAVEDRA MD (PRESIDENT)
- **Authorized official phone:** (954) 499-7878

## Contact information

- **Practice address:** 18503 PINES BLVD, SUITE 303, PEMBROKE PINES, FL 33029-1404
- **Practice address phone:** (954) 499-7878
- **Practice address fax:** (954) 499-7877
- **Mailing address:** 18503 PINES BLVD, SUITE 303, PEMBROKE PINES, FL 33029-1404
- **Mailing address phone:** (954) 499-7878
- **Mailing address fax:** (954) 499-7877

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | ME32736 | FL | Yes |

## Other

- **Enumeration date:** 07/29/2006
- **Last updated:** 06/19/2008