Provider Demographics
NPI:1093542011
Name:GONZALEZ, BETSY NORMA
Entity type:Individual
Prefix:
First Name:BETSY
Middle Name:NORMA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10981 SW 5TH ST # 33174
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1321
Mailing Address - Country:US
Mailing Address - Phone:786-727-5868
Mailing Address - Fax:
Practice Address - Street 1:10981 SW 5TH ST # 33174
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1321
Practice Address - Country:US
Practice Address - Phone:786-727-5868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLG524-074-80-962-0171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator