MEDICARE: MRS. ROXANA MARIA GONZALEZ POUZA MAC

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	171100000X	Acupuncturist	AP1387	FL

General Provider Information

NPI Number	:	1871638098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROXANA MARIA GONZALEZ POUZA MAC

Provider Business Mailing Address
First Line	:	7550 SW 57TH AVE STE 116
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-5331
Country	:	US
Telephone Number	:	305-669-6699
Fax Number	:	305-940-0059

Provider Business Practice Location Address
First Line	:	7550 SW 57TH AVE STE 116
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-5331
Country	:	US
Telephone Number	:	305-669-6699
Fax Number	:	305-940-0059

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	10/05/2020

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