Provider Demographics
NPI:1043946338
Name:GONZALEZ, ANNITZA
Entity Type:Individual
Prefix:
First Name:ANNITZA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7524 SOUTHSIDE BLVD APT 1006
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0401
Mailing Address - Country:US
Mailing Address - Phone:787-383-6550
Mailing Address - Fax:
Practice Address - Street 1:7524 SOUTHSIDE BLVD APT 1006
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0401
Practice Address - Country:US
Practice Address - Phone:787-383-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist