Healthcare Provider Details

I. General information

NPI: 1093936908
Provider Name (Legal Business Name): NOEMA M GONZALEZ RT (R) (CT)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9788 SW 24TH ST
MIAMI FL
33165-7574
US

IV. Provider business mailing address

15437 SW 71ST ST
MIAMI FL
33193-2108
US

V. Phone/Fax

Practice location:
  • Phone: 305-387-9250
  • Fax: 305-223-4001
Mailing address:
  • Phone: 305-387-9250
  • Fax: 305-223-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License NumberCRT60455
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: