Healthcare Provider Details

I. General information

NPI: 1437369402
Provider Name (Legal Business Name): MIRTHA DEL PILAR GONZALEZ MSN, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

IV. Provider business mailing address

15060 SW 68TH LN
MIAMI FL
33193-2007
US

V. Phone/Fax

Practice location:
  • Phone: 305-666-6511
  • Fax: 786-268-1848
Mailing address:
  • Phone: 305-382-9381
  • Fax: 786-268-1848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1223212
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: