Healthcare Provider Details

I. General information

NPI: 1760145197
Provider Name (Legal Business Name): MARIA DE LOS ANGELES GONZALEZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 E 19TH ST
HIALEAH FL
33013-4129
US

IV. Provider business mailing address

567 E 19TH ST
HIALEAH FL
33013-4129
US

V. Phone/Fax

Practice location:
  • Phone: 305-215-5198
  • Fax:
Mailing address:
  • Phone: 305-215-5198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11015786
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: