Provider Demographics
NPI:1033744990
Name:GONZALEZ, TANIA G
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:G
Last Name: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 1:7226 SW 94TH PL APT F1
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3277
Mailing Address - Country:US
Mailing Address - Phone:786-474-5965
Mailing Address - Fax:
Practice Address - Street 1:7226 SW 94TH PL APT F1
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3277
Practice Address - Country:US
Practice Address - Phone:786-474-5965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician