1447558036 NPI number — JUAN CARLOS GONZALEZ LMFT

Table of content: JUAN CARLOS GONZALEZ LMFT (NPI 1447558036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447558036 NPI number — JUAN CARLOS GONZALEZ LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ
Provider First Name:
JUAN CARLOS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447558036
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7765 SW 87TH AVE STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33173-2535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-229-2614
Provider Business Mailing Address Fax Number:
305-412-8447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9075 SW 87TH AVE
Provider Second Line Business Practice Location Address:
SUITE 411
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33176-2308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-229-2614
Provider Business Practice Location Address Fax Number:
786-477-6010
Provider Enumeration Date:
03/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MT2303 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 005851400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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