Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PY0005873 | FL |
N | 103TC0700X | Clinical Psychologist | PY0005873 | FL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PY0005873 | FL |
NPI | 1053519900 |
---|---|
Provider Name | Dr. Ketty Patino Gonzalez |
First Address | Coral Gables, FL 33146-2435 |
Second Address | Coral Gables, FL 33146-2435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 08/07/2007 |