Healthcare Provider Details

I. General information

NPI: 1386168540
Provider Name (Legal Business Name): JAVIER TOMAS GONZALEZ MUNIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 07/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14335 SW 120TH ST STE 110
MIAMI FL
33186-7295
US

IV. Provider business mailing address

920 SW 43RD AVE
MIAMI FL
33134-2646
US

V. Phone/Fax

Practice location:
  • Phone: 786-359-4999
  • Fax: 786-359-4843
Mailing address:
  • Phone: 786-209-5926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9386179
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: