Provider Demographics
NPI:1265848345
Name:GONZALEZ, CHARISE
Entity Type:Individual
Prefix:
First Name:CHARISE
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 1:12494 SW 127TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6597
Mailing Address - Country:US
Mailing Address - Phone:305-255-5980
Mailing Address - Fax:305-255-9766
Practice Address - Street 1:12494 SW 127TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6597
Practice Address - Country:US
Practice Address - Phone:305-255-5980
Practice Address - Fax:305-255-9766
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ6717235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist