Healthcare Provider Details

I. General information

NPI: 1497583355
Provider Name (Legal Business Name): SENEN ORAMA GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 NW 107TH AVE STE 110
MIAMI FL
33172-3100
US

IV. Provider business mailing address

15819 SW 99TH ST
MIAMI FL
33196-6110
US

V. Phone/Fax

Practice location:
  • Phone: 305-964-5426
  • Fax: 305-964-5624
Mailing address:
  • Phone: 786-731-5544
  • 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: