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General NPI Number Information
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NPI Number | 1962931717
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Entity Type | Individual
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Provider Name | MAURICIO OSCAR GONZALEZ REYNALDO SR. OTR/L
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Gender | Male
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Dates
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Enumeration Date | 06/06/2017
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 6165 SW 130TH AVE APT 1310
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City | MIAMI
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State | FL
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Zip | 33183-5234
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Country | US
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Telephone | 786-370-8729
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Fax | 305-830-9043
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Provider Business Mailing Address
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Address Line | 6165 SW 130TH AVE APT 1310
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City | MIAMI
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State | FL
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Zip | 33183-5234
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Country | US
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Telephone | 786-370-8729
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Fax | 305-830-9043
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT20252
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License Number State | FL
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