Provider Demographics
NPI:1194021303
Name:GONZALEZ-AZOFEIFA, INGRID (LMT)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:GONZALEZ-AZOFEIFA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4383 NORTHLAKE BLVD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6253
Mailing Address - Country:US
Mailing Address - Phone:561-775-4900
Mailing Address - Fax:561-775-0003
Practice Address - Street 1:4383 NORTHLAKE BLVD
Practice Address - Street 2:SUITE 309
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6253
Practice Address - Country:US
Practice Address - Phone:561-775-4900
Practice Address - Fax:561-775-0003
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA60561225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist