Provider Demographics
NPI:1114564150
Name:GONZALEZ ODIO, CESAR
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:
Last Name:GONZALEZ ODIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-5531
Mailing Address - Country:US
Mailing Address - Phone:754-610-1472
Mailing Address - Fax:
Practice Address - Street 1:1426 MONROE ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-5531
Practice Address - Country:US
Practice Address - Phone:754-610-1472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-105521106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician