Healthcare Provider Details

I. General information

NPI: 1518893544
Provider Name (Legal Business Name): AILEEN MIA GONZALEZ SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 SUNSET DR STE 153
MIAMI FL
33173-3038
US

IV. Provider business mailing address

13160 SW 64TH TER APT 1602
MIAMI FL
33183-5635
US

V. Phone/Fax

Practice location:
  • Phone: 786-212-1399
  • Fax: 786-401-6642
Mailing address:
  • Phone: 786-212-1399
  • Fax: 786-401-6642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI8827
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: