Healthcare Provider Details

I. General information

NPI: 1013419183
Provider Name (Legal Business Name): ARIADNA GONZALEZ BERMUDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18300 NW 62ND AVE STE 200
HIALEAH FL
33015-8207
US

IV. Provider business mailing address

18300 NW 62ND AVE STE 200
HIALEAH FL
33015-8207
US

V. Phone/Fax

Practice location:
  • Phone: 786-304-7731
  • Fax: 786-353-2349
Mailing address:
  • Phone: 786-304-7731
  • Fax: 786-353-2349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW22064
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: