Provider Demographics
NPI:1053863076
Name:ROMERO GONZALEZ, KIRENIA
Entity Type:Individual
Prefix:
First Name:KIRENIA
Middle Name:
Last Name:ROMERO 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 1:9130 NW 162ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6302
Mailing Address - Country:US
Mailing Address - Phone:786-870-3174
Mailing Address - Fax:
Practice Address - Street 1:9130 NW 162ND TER
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33018-6302
Practice Address - Country:US
Practice Address - Phone:786-870-3174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0-18-8690106E00000X
CO1-21-48164103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019541300Medicaid