Basic Information
| Provider Information | |||||||||
| NPI: | 1891900759 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | ISANDRA | ||||||||
| MiddleName: | MARGARITA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 725 NW 128TH AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331821888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055931961 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9380 SW 72ND ST | ||||||||
| Address2: | SUITE B-120 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331733276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052743172 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | ISW 3512 | FL | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.