Healthcare Provider Details

I. General information

NPI: 1245804053
Provider Name (Legal Business Name): KRAEHL GONELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 SW 1ST ST
MIAMI FL
33135-1601
US

IV. Provider business mailing address

5941 SW 13TH TER
WEST MIAMI FL
33144-5739
US

V. Phone/Fax

Practice location:
  • Phone: 305-631-8931
  • Fax:
Mailing address:
  • Phone: 786-901-0863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: