Provider Demographics
NPI:1831279041
Name:GONZALEZ-TORRES, BLANCA GLORIA (SLP-A, DT)
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:GLORIA
Last Name:GONZALEZ-TORRES
Suffix:
Gender:F
Credentials:SLP-A, DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9365 SW 36TH ST
Mailing Address - Street 2:APT. B
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4119
Mailing Address - Country:US
Mailing Address - Phone:305-228-4873
Mailing Address - Fax:
Practice Address - Street 1:8491 NW 17TH ST STE 100
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1025
Practice Address - Country:US
Practice Address - Phone:305-456-5542
Practice Address - Fax:786-364-0119
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
FLSI 13582355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist