Healthcare Provider Details

I. General information

NPI: 1023356508
Provider Name (Legal Business Name): MAIRELYS GONZALEZ BOSCH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 07/21/2022
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 SW 24TH ST
MIAMI FL
33165-7598
US

IV. Provider business mailing address

9750 SW 24TH ST
MIAMI FL
33165-7598
US

V. Phone/Fax

Practice location:
  • Phone: 786-456-9003
  • Fax: 786-456-9005
Mailing address:
  • Phone: 786-456-9003
  • Fax: 786-456-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME128528
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: