Provider Demographics
NPI:1851684179
Name:GONZALEZ, MILEIDIS SR
Entity type:Individual
Prefix:MS
First Name:MILEIDIS
Middle Name:
Last Name:GONZALEZ
Suffix:SR
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 1:8567 CORAL WAY # 188
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2335
Mailing Address - Country:US
Mailing Address - Phone:786-991-4400
Mailing Address - Fax:305-220-5015
Practice Address - Street 1:901 SW 137TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-3026
Practice Address - Country:US
Practice Address - Phone:786-991-4400
Practice Address - Fax:305-220-5015
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 62651225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist