Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | SS1411 | FL |
NPI | 1003449034 |
---|---|
Provider Name | Jamie Gonzalez |
First Address | Miami, FL 33173-1565 |
Second Address | Miami, FL 33173-3255 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2020 |
Last Update Date | 18/02/2020 |