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General NPI Number Information
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NPI Number | 1497103113
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Entity Type | Individual
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Provider Name | KETTY GONZALEZ
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Gender | Female
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Dates
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Enumeration Date | 06/03/2016
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Last Update Date | 06/03/2016
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Provider Practice Location Address
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Address Line | 12855 SW 132ND ST SUITE 207
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City | MIAMI
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State | FL
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Zip | 33186-7207
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Country | US
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Telephone | 786-587-0424
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Fax | 786-250-5094
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Provider Business Mailing Address
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Address Line | 771 SE 2ND PL
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City | HIALEAH
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State | FL
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Zip | 33010-5405
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Country | US
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Telephone | 305-801-5996
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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