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General NPI Number Information
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NPI Number | 1326698093
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Entity Type | Individual
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Provider Name | JAVIER JESUS GONZALEZ PTA
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Gender | Male
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Dates
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Enumeration Date | 09/16/2019
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Last Update Date | 09/16/2019
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Provider Practice Location Address
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Address Line | 7401 MIAMI LAKES DR
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City | MIAMI LAKES
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State | FL
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Zip | 33014-6818
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Country | US
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Telephone | 786-500-7868
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Fax | 305-512-6061
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Provider Business Mailing Address
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Address Line | 15579 MIAMI LAKEWAY N APT 102
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City | MIAMI LAKES
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State | FL
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Zip | 33014-5588
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Country | US
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Telephone | 786-390-0878
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 29751
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License Number State | FL
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