Individual
GONZALO JAVIER CARRIZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2380 HARBOR BLVD, PORT CHARLOTTE, FL 33952-5024
(941) 260-0325
(941) 766-0423
Mailing address
2380 HARBOR BLVD, PORT CHARLOTTE, FL 33952-5024
(941) 260-0325
(941) 766-0423
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
35.131527
OH
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
ME103088
FL
390200000X
Student in an Organized Health Care Education/Training Program
TL-1905
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000612700
—
FL
01
—
P00717548
RR MEDICARE
FL
Enumeration date
01/30/2007
Last updated
03/22/2019
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