Provider Demographics
NPI:1619262698
Name:GONZALEZ, TAYMEE
Entity type:Individual
Prefix:
First Name:TAYMEE
Middle Name:
Last Name: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 1:15500 SW 80TH ST
Mailing Address - Street 2:APT 203
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-3370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15500 SW 80TH ST
Practice Address - Street 2:APT 203
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-3370
Practice Address - Country:US
Practice Address - Phone:786-306-2906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA63345261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service