| Doctor Name: | OMAIRA LUZ GONZALEZ |
| NPI Number: | 1801211867 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 3338 Sepia St W Melbourne, FL - 329047585 |
| Business Phone Number: | 3216935365 |
| Business Fax Number: | |
| Mailing Address: | 3338 Sepia St, W MELBOURNE |
| State: | FL |
| Postal Code: | 329047585 |
| Phone Number: | 3216935365 |
| Fax Number: | |
| NPI Enumeration Date: | 02/27/2014 |
| NPI Last Update Date: | 03/27/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |