Healthcare Provider Details

I. General information

NPI: 1629692009
Provider Name (Legal Business Name): MILADYS GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8785 SW 165TH AVE STE 101
MIAMI FL
33193-5827
US

IV. Provider business mailing address

3603 SW 150TH CT
MIAMI FL
33185-3995
US

V. Phone/Fax

Practice location:
  • Phone: 305-880-0004
  • Fax: 305-388-8009
Mailing address:
  • Phone: 786-925-6057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10857
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: