Provider Demographics
NPI:1588902753
Name:GONZALEZ, FATIMA (IBCLC)
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 CORAL WAY
Mailing Address - Street 2:APARTMENT 304
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4925
Mailing Address - Country:US
Mailing Address - Phone:305-799-2530
Mailing Address - Fax:
Practice Address - Street 1:525 CORAL WAY
Practice Address - Street 2:APARTMENT 304
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4925
Practice Address - Country:US
Practice Address - Phone:305-799-2530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11084625174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN