Healthcare Provider Details

I. General information

NPI: 1467399865
Provider Name (Legal Business Name): ERIKA GONZALEZ-REBULL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 SW 111TH ST
PINECREST FL
33156-4105
US

IV. Provider business mailing address

5900 SW 111TH ST
PINECREST FL
33156-4105
US

V. Phone/Fax

Practice location:
  • Phone: 786-797-4430
  • Fax:
Mailing address:
  • Phone: 786-797-4430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND9394
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: