MEDICARE: MONICA GONZALEZ MED.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH11893	FL

General Provider Information

NPI Number	:	1225450257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA GONZALEZ MED.

Provider Business Mailing Address
First Line	:	5835 TARRAGON DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-7033
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	224 DATURA ST
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-5624
Country	:	US
Telephone Number	:	646-554-1087
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2014
Last Update Date	:	05/27/2015

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