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General NPI Number Information
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NPI Number | 1023434370
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Entity Type | Organization
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Legal Business Name | EFRAIN A. GONZALEZ PL
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Dates
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Enumeration Date | 03/11/2014
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Last Update Date | 06/09/2014
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Provider Practice Location Address
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Address Line | 2730 SW 3RD AVE STE 202A
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City | MIAMI
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State | FL
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Zip | 33129-2323
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Country | US
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Telephone | 305-218-5540
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Fax |
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Provider Business Mailing Address
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Address Line | 8589 SW 115TH PL
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City | MIAMI
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State | FL
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Zip | 33173-4202
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Country | US
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Telephone | 305-218-5540
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. EFRAIN ANTONIO GONZALEZ
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Credential | PSY.D.
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Telephone | 305-218-5540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY3731
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License Number State | FL
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