Provider Demographics
NPI:1073290722
Name:GONZALEZ AGUILAR, EVELIN BEATRIZ
Entity Type:Individual
Prefix:
First Name:EVELIN
Middle Name:BEATRIZ
Last Name:GONZALEZ AGUILAR
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 1:951 SW 100TH TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-0906
Mailing Address - Country:US
Mailing Address - Phone:754-816-0185
Mailing Address - Fax:
Practice Address - Street 1:5100 W COPANS RD STE 300
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-7700
Practice Address - Country:US
Practice Address - Phone:954-825-3317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-276229106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician