Provider Demographics
NPI:1538674908
Name:GONZALEZ, MARIA D (MASSAGE THERAPIST MA)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:D
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4578 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3325
Mailing Address - Country:US
Mailing Address - Phone:305-828-1989
Mailing Address - Fax:
Practice Address - Street 1:4578 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3325
Practice Address - Country:US
Practice Address - Phone:305-828-1989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA67101225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA67101OtherMASSAGE THERAPIST