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General NPI Number Information
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NPI Number | 1952671083
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Entity Type | Individual
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Provider Name | GEORGINA GONZALEZ LMT
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Gender | Female
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Dates
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Enumeration Date | 01/05/2012
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Last Update Date | 01/05/2012
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Provider Practice Location Address
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Address Line | 900 W 49TH ST SUITE 410
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City | HIALEAH
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State | FL
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Zip | 33012-3402
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Country | US
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Telephone | 305-825-2131
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Fax | 305-825-2585
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Provider Business Mailing Address
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Address Line | 4783 E 9TH CT
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City | HIALEAH
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State | FL
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Zip | 33013-2025
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Country | US
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Telephone | 786-908-2959
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA 64101
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License Number State | FL
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