MEDICARE: OSVALDO GONZALEZ CBHCM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1346868627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OSVALDO GONZALEZ CBHCM

Provider Business Mailing Address
First Line	:	14902 SW 173RD TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33187-6756
Country	:	US
Telephone Number	:	786-564-0178
Fax Number	:

Provider Business Practice Location Address
First Line	:	14902 SW 173RD TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33187-6756
Country	:	US
Telephone Number	:	786-564-0178
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2020
Last Update Date	:	07/13/2020

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Directions to “ OSVALDO GONZALEZ CBHCM” Practice Location

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