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Individual

KAILEN GONZALEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
4571 COLONIAL BLVD STE 110, FORT MYERS, FL 33966-1156
(786) 218-3593
Mailing address
2234 COLONIAL BLVD, FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9113094
FL
363AM0700X
Medical Physician Assistant
Primary
9113094
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
111378700
FL
05
1434PA
SC
01
19BS6
BCBS
SC
01
3H9GM
BCBS
FL
01
80025208
SELECT HEALTH
SC
01
956511
WELLCARE
SC
01
9673961
AETNA
SC
01
P01074499
RAILROAD MEDICARE
SC
Enumeration date
03/29/2012
Last updated
05/25/2022
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