Provider Demographics
NPI:1710420880
Name:GONZALEZ, ANA (LAC, DOM, LMT)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LAC, DOM, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 SW 116TH CT
Mailing Address - Street 2:APT 309
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1721
Mailing Address - Country:US
Mailing Address - Phone:786-505-8863
Mailing Address - Fax:
Practice Address - Street 1:8056 SW 81ST DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-6609
Practice Address - Country:US
Practice Address - Phone:786-505-8863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3773171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist