Healthcare Provider Details

I. General information

NPI: 1629668785
Provider Name (Legal Business Name): MIRIALA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 E 41ST ST
HIALEAH FL
33013-2453
US

IV. Provider business mailing address

5858 W 18TH AVE
HIALEAH FL
33012-7597
US

V. Phone/Fax

Practice location:
  • Phone: 786-600-7560
  • Fax: 786-648-5503
Mailing address:
  • Phone:
  • Fax:

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 Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11030874
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: