Individual
LUCERITO GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
338 SAHALLI CT, DAVENPORT, FL 33837-8779
(410) 322-0940
Mailing address
338 SAHALLI CT, DAVENPORT, FL 33837-8779
(410) 322-0940
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
15814
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
15814
—
FL
Enumeration date
05/11/2017
Last updated
05/11/2017
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