Provider Demographics
NPI:1770192361
Name:BARZAGA GONZALEZ, IMILSY
Entity Type:Individual
Prefix:
First Name:IMILSY
Middle Name:
Last Name:BARZAGA 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 1:1004 MARLENE DR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3232
Mailing Address - Country:US
Mailing Address - Phone:132-194-8801
Mailing Address - Fax:
Practice Address - Street 1:1004 MARLENE DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3232
Practice Address - Country:US
Practice Address - Phone:132-194-8801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225C00000X225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor