MEDICARE: DIANA GONZALEZ

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1750146502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA GONZALEZ

Provider Business Mailing Address
First Line	:	3955 W 8TH CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7292
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3955 W 8TH CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7292
Country	:	US
Telephone Number	:	813-679-8839
Fax Number	:

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

Provider Enumeration Date	:	02/20/2024
Last Update Date	:	02/20/2024

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Directions to “ DIANA GONZALEZ ” Practice Location

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