Provider Demographics
NPI:1003676495
Name:RON GONZALEZ, MARIA DE LOS ANGELES
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DE LOS ANGELES
Last Name:RON GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11073 LAGUNA BAY DR APT 113
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-5567
Mailing Address - Country:US
Mailing Address - Phone:407-301-3012
Mailing Address - Fax:
Practice Address - Street 1:11073 LAGUNA BAY DR APT 113
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32821-5567
Practice Address - Country:US
Practice Address - Phone:407-301-3012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24335214106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician