Provider Demographics
NPI:1699490961
Name:MOLLER GONZALEZ, ASTRID (MS)
Entity type:Individual
Prefix:
First Name:ASTRID
Middle Name:
Last Name:MOLLER GONZALEZ
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12203 NW 23RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33167-1489
Mailing Address - Country:US
Mailing Address - Phone:804-638-3717
Mailing Address - Fax:
Practice Address - Street 1:680 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-2113
Practice Address - Country:US
Practice Address - Phone:804-638-3717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist