Provider Demographics
NPI:1902852924
Name:MARIA DE JESUS GONZALEZ
Entity Type:Organization
Organization Name:MARIA DE JESUS GONZALEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:DE JESUS
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:305-231-1544
Mailing Address - Street 1:6043 NW 167TH ST
Mailing Address - Street 2:SUITE A11
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4326
Mailing Address - Country:US
Mailing Address - Phone:305-231-1544
Mailing Address - Fax:
Practice Address - Street 1:6043 NW 167TH ST
Practice Address - Street 2:SUITE A11
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33015-4326
Practice Address - Country:US
Practice Address - Phone:305-231-1544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 14991174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT 14991OtherLICENSE NUMBER