Provider Demographics
NPI:1093329658
Name:GONZALEZ RIPOLL, IDALMA (RBT)
Entity Type:Individual
Prefix:MRS
First Name:IDALMA
Middle Name:
Last Name:GONZALEZ RIPOLL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 NW 191ST TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-2237
Mailing Address - Country:US
Mailing Address - Phone:786-343-4676
Mailing Address - Fax:
Practice Address - Street 1:4010 NW 191ST TER
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2237
Practice Address - Country:US
Practice Address - Phone:786-343-4676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-127386106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician