Provider Demographics
NPI:1336471325
Name:GONZALEZ, MARISA CRISTINA
Entity Type:Individual
Prefix:MS
First Name:MARISA
Middle Name:CRISTINA
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 1:7990 SW 117TH AVE
Mailing Address - Street 2:SUITE 136-A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3845
Mailing Address - Country:US
Mailing Address - Phone:305-275-0606
Mailing Address - Fax:305-275-0605
Practice Address - Street 1:7990 SW 117TH AVE
Practice Address - Street 2:SUITE 136-A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-3845
Practice Address - Country:US
Practice Address - Phone:305-275-0606
Practice Address - Fax:305-275-0605
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7397235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist