Provider Demographics
NPI:1841439353
Name:GILBERT-GONZALEZ, LOURDES MICHELLE
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:MICHELLE
Last Name:GILBERT-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 1:6200 SW 73RD ST
Mailing Address - Street 2:CHILD DEVELOPMENT CENTER
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4679
Mailing Address - Country:US
Mailing Address - Phone:786-662-5080
Mailing Address - Fax:786-662-5081
Practice Address - Street 1:5975 SUNSET DR
Practice Address - Street 2:SUITE 100 CHILD DEVELOPMENT CENTER
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5166
Practice Address - Country:US
Practice Address - Phone:786-662-5080
Practice Address - Fax:786-662-5081
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 8235235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010058700Medicaid
FL1982688230OtherHOSPITAL