Provider Demographics
NPI:1093433740
Name:GONZALEZ OLIVA, BETSABE
Entity Type:Individual
Prefix:
First Name:BETSABE
Middle Name:
Last Name:GONZALEZ OLIVA
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 1:14921 SW 283RD ST APT 105
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-1583
Mailing Address - Country:US
Mailing Address - Phone:786-406-3533
Mailing Address - Fax:
Practice Address - Street 1:24799 SW 112TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-7100
Practice Address - Country:US
Practice Address - Phone:305-257-3233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS64634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist