Provider Demographics
NPI:1073383717
Name:VALDESPINO GONZALEZ, ADRIANA
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:VALDESPINO 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 1:6345 PINESTEAD DR APT 1123
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-7116
Mailing Address - Country:US
Mailing Address - Phone:702-994-3357
Mailing Address - Fax:
Practice Address - Street 1:1490 S MILITARY TRL STE 7
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-9141
Practice Address - Country:US
Practice Address - Phone:561-323-2552
Practice Address - Fax:561-557-9557
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-314889106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty