Provider Demographics
NPI:1346741543
Name:GONZALEZ, MARIELA A
Entity Type:Individual
Prefix:
First Name:MARIELA
Middle Name:A
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 1:11890 SW 8TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1742
Mailing Address - Country:US
Mailing Address - Phone:786-534-8408
Mailing Address - Fax:786-773-2612
Practice Address - Street 1:11890 SW 8TH ST STE 210
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1742
Practice Address - Country:US
Practice Address - Phone:786-534-8408
Practice Address - Fax:786-773-2612
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022309200Medicaid