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General NPI Number Information
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NPI Number | 1609680776
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Entity Type | Organization
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Legal Business Name | ACTIVA MEDICAL CENTER & SPA
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Dates
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Enumeration Date | 02/06/2025
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 12966 SW 150TH TER
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City | MIAMI
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State | FL
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Zip | 33186-7601
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Country | US
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Telephone | 786-406-2497
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Fax |
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Provider Business Mailing Address
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Address Line | 11090 SW 64TH ST
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City | MIAMI
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State | FL
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Zip | 33173-2028
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Country | US
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Telephone | 786-317-9247
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MRS. AIMEE TERESA GONZALEZ
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Credential | APRN
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Telephone | 786-317-9247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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