Provider Demographics
NPI:1053844050
Name:GONZALEZ DIEGUEZ, ANA M
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:M
Last Name:GONZALEZ DIEGUEZ
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 1:15821 NW 52ND AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6213
Mailing Address - Country:US
Mailing Address - Phone:786-319-1656
Mailing Address - Fax:
Practice Address - Street 1:15821 NW 52ND AVE APT 106
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-6213
Practice Address - Country:US
Practice Address - Phone:786-319-1656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst