Provider Demographics
NPI:1790094670
Name:GONZALEZ, MARIA ROSARIO (MW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ROSARIO
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 SW 29TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4518
Mailing Address - Country:US
Mailing Address - Phone:786-553-0527
Mailing Address - Fax:
Practice Address - Street 1:1045 SW 29TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4518
Practice Address - Country:US
Practice Address - Phone:786-553-0527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW159176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340348300Medicaid