Gonsalves, Lisa

Gonsalves, Lisa is an individual health care provider with primary practice located at 335 Clyde Morris Blvd Suite 240, Ormond Beach FL 32174-3181. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Gonsalves, Lisa can be contacted via phone (386) 231-3561.

Contact Information

Primary practice address
335 Clyde Morris Blvd Suite 240 Ormond Beach FL 32174-3181
Phone: (386) 231-3561
Fax: (386) 677-6501
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X ME0060521 Florida

Profile Details

NPI number 1114997616
LBN Legal business name Gonsalves, Lisa
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 25th, 2006
Last updated Jun 21st, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114997616 NPPES
Florida MEDICAID 372053500

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