Provider Demographics
NPI:1376134759
Name:GONZALEZ, ROSA MARITZA (DRIVER LICENSES)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:MARITZA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DRIVER LICENSES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5276 NE 6TH AVE
Mailing Address - Street 2:APT. 19 G
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334
Mailing Address - Country:US
Mailing Address - Phone:754-235-6254
Mailing Address - Fax:
Practice Address - Street 1:5276 NE 6TH AVE APT 19G
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-3329
Practice Address - Country:US
Practice Address - Phone:754-235-6254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA85668225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist