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General NPI Number Information
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NPI Number | 1750785457
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Entity Type | Individual
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Provider Name | MRS. CINTHYA M GONZALEZ REVERON
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Gender | Female
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Dates
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Enumeration Date | 10/09/2014
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 2215 N AMERICAN STREET
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City | PHILADELPHIA
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State | PA
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Zip | 19133
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Country | US
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Telephone | 215-425-6203
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Fax | 215-425-6204
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Provider Business Mailing Address
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Address Line | 444 N STERLING RD
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City | ELKINS PARK
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State | PA
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Zip | 19027-2033
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Country | US
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Telephone | 787-585-3619
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2074
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SL012792
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License Number State | PA
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