Healthcare Provider Details

I. General information

NPI: 1598444960
Provider Name (Legal Business Name): PAULINA GONZALEZ RUL MS, LDN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21301 POWERLINE RD STE 107
BOCA RATON FL
33433-2389
US

IV. Provider business mailing address

6181 CYPRESS HOLLOW WAY
NAPLES FL
34109-5904
US

V. Phone/Fax

Practice location:
  • Phone: 561-299-1164
  • Fax: 561-567-7756
Mailing address:
  • Phone: 646-401-4267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberND11496
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: