Organization
SPACE COAST UROLOGY, LLC
Active
Other names
Justo Gonzalez, M.D.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTO GONZALEZ M.D. (UROLOGIST)
(321) 268-4693
Entity
Organization
Contact information
Practice address
2203 GARDEN ST, TITUSVILLE, FL 32796-2577
(321) 268-4693
(321) 268-4696
Mailing address
2203 GARDEN ST, TITUSVILLE, FL 32796-2577
(321) 268-4693
(321) 268-4696
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME67177
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
271696800
—
FL
Enumeration date
10/11/2007
Last updated
03/13/2009
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