MEDICARE: ROSA MARITZA GONZALEZ DRIVER LICENSES

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	225700000X	Massage Therapist	MA85668	FL

General Provider Information

NPI Number	:	1376134759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSA MARITZA GONZALEZ DRIVER LICENSES

Provider Business Mailing Address
First Line	:	5276 NE 6TH AVE
Second Line	:	APT. 19 G
City	:	OAKLAND PARK
State	:	FL
Zip	:	33334
Country	:	US
Telephone Number	:	754-235-6254
Fax Number	:

Provider Business Practice Location Address
First Line	:	5276 NE 6TH AVE APT 19G
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33334-3329
Country	:	US
Telephone Number	:	754-235-6254
Fax Number	:

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

Provider Enumeration Date	:	01/28/2021
Last Update Date	:	01/28/2021

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Directions to “ ROSA MARITZA GONZALEZ DRIVER LICENSES” Practice Location

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