# ACTIVA MEDICAL CENTER & SPA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609680776
- **Authorized official:** MRS. AIMEE TERESA GONZALEZ APRN (FAMILY NURSE PRACTITIONER)
- **Authorized official phone:** (786) 317-9247

## Contact information

- **Practice address:** 12966 SW 150TH TER, MIAMI, FL 33186-7601
- **Practice address phone:** (786) 406-2497
- **Mailing address:** 11090 SW 64TH ST, MIAMI, FL 33173-2028
- **Mailing address phone:** (786) 317-9247

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/06/2025
- **Last updated:** 02/06/2025