Healthcare Provider Details

I. General information

NPI: 1093542011
Provider Name (Legal Business Name): BETSY NORMA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2024
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10981 SW 5TH ST
MIAMI FL
33174-1321
US

IV. Provider business mailing address

10981 SW 5TH ST
MIAMI FL
33174-1321
US

V. Phone/Fax

Practice location:
  • Phone: 786-727-5868
  • Fax:
Mailing address:
  • Phone: 786-727-5868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberG524-074-80-962-0
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: