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General NPI Number Information
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NPI Number | 1194199810
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Entity Type | Individual
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Provider Name | MICHAEL J GONZALEZ MACP
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Gender | Male
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Dates
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Enumeration Date | 11/18/2015
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 20000 NW 47TH AVE HECTOR BUILDING (#2)
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City | MIAMI GARDENS
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State | FL
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Zip | 33055-1543
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Country | US
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Telephone | 305-430-0085
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Fax | 305-474-1312
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Provider Business Mailing Address
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Address Line | 20000 NW 47TH AVE HECTOR BUILDING (#2)
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City | MIAMI GARDENS
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State | FL
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Zip | 33055-1543
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Country | US
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Telephone | 305-430-0085
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Fax | 305-474-1312
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH11450
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License Number State | FL
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