Provider Demographics
NPI:1093225906
Name:GONZALEZ GRIEGO, MARTHA D
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:D
Last Name:GONZALEZ GRIEGO
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 1:8500 SW 133RD AVENUE RD APT 321
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4585
Mailing Address - Country:US
Mailing Address - Phone:786-915-2300
Mailing Address - Fax:
Practice Address - Street 1:8500 SW 133RD AVENUE RD APT 321
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183
Practice Address - Country:US
Practice Address - Phone:786-915-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician