Healthcare Provider Details

I. General information

NPI: 1962446013
Provider Name (Legal Business Name): CAMILLE GONZALEZ PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST MIAMI VAMC
MIAMI FL
33125-1624
US

IV. Provider business mailing address

4000 NE 169TH ST #206
NORTH MIAMI BEACH FL
33160-3287
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-7000
  • Fax:
Mailing address:
  • Phone: 305-575-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 7019
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: