MEDICARE: JOHANNA 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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1801144910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHANNA GONZALEZ

Provider Business Mailing Address
First Line	:	2030 S DOUGLAS RD
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4615
Country	:	US
Telephone Number	:	786-232-1605
Fax Number	:

Provider Business Practice Location Address
First Line	:	2030 S DOUGLAS RD
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4615
Country	:	US
Telephone Number	:	786-232-1605
Fax Number	:

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

Provider Enumeration Date	:	08/21/2012
Last Update Date	:	08/21/2012

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Directions to “ JOHANNA GONZALEZ ” Practice Location

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