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General NPI Number Information
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NPI Number | 1679312805
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Entity Type | Individual
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Provider Name | TABATA VERUSHKA GONZALEZ
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Gender | Female
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 13397 SW 131ST ST
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City | MIAMI
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State | FL
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Zip | 33186-5816
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Country | US
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Telephone | 786-253-3090
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Fax |
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Provider Business Mailing Address
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Address Line | 9490 NW 41ST ST APT 522
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City | DORAL
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State | FL
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Zip | 33178-4970
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Country | US
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Telephone | 754-303-8118
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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 | PTA33112
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License Number State | FL
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