Healthcare Provider Details

I. General information

NPI: 1174468144
Provider Name (Legal Business Name): ERIKA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 SW 103RD AVE
MIAMI FL
33176-3517
US

IV. Provider business mailing address

10500 SW 103RD AVE
MIAMI FL
33176-3517
US

V. Phone/Fax

Practice location:
  • Phone: 786-259-7499
  • Fax:
Mailing address:
  • Phone: 786-259-7499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number9370664
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: