Provider Demographics
NPI:1205657822
Name:GONZALEZ HERNANDEZ, TALIA MICHELLE
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:MICHELLE
Last Name:GONZALEZ HERNANDEZ
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 1:6620 SW 57TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-7133
Mailing Address - Country:US
Mailing Address - Phone:787-346-8615
Mailing Address - Fax:
Practice Address - Street 1:6620 SW 57TH ST
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-7133
Practice Address - Country:US
Practice Address - Phone:787-346-8615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program