Provider Demographics
NPI:1396022711
Name:GONZALEZ, DULCE
Entity Type:Individual
Prefix:
First Name:DULCE
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 1:215 SW 17TH AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-3674
Mailing Address - Country:US
Mailing Address - Phone:305-631-2047
Mailing Address - Fax:305-631-2361
Practice Address - Street 1:215 SW 17TH AVE STE 210
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3674
Practice Address - Country:US
Practice Address - Phone:305-631-2047
Practice Address - Fax:305-631-2361
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA65510172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist