Healthcare Provider Details

I. General information

NPI: 1063342863
Provider Name (Legal Business Name): ANDREA V GONZALEZ M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 NW 57TH AVE STE 305B
MIAMI FL
33126-2385
US

IV. Provider business mailing address

15660 SW 82ND CIRCLE LN APT 61
MIAMI FL
33193-5043
US

V. Phone/Fax

Practice location:
  • Phone: 305-741-0301
  • Fax:
Mailing address:
  • Phone: 954-673-4326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH26963
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: