Healthcare Provider Details

I. General information

NPI: 1063384162
Provider Name (Legal Business Name): VIAIDYS GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6990 NW 186TH ST APT 111
HIALEAH FL
33015-3132
US

IV. Provider business mailing address

6990 NW 186TH ST APT 111
HIALEAH FL
33015-3132
US

V. Phone/Fax

Practice location:
  • Phone: 786-473-4173
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: