Provider Demographics
NPI:1164099396
Name:GUZMAN GONZALEZ, YADIRA (RBT)
Entity Type:Individual
Prefix:
First Name:YADIRA
Middle Name:
Last Name:GUZMAN GONZALEZ
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 1:650 SE 9TH CT APT 105
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5767
Mailing Address - Country:US
Mailing Address - Phone:786-806-2221
Mailing Address - Fax:
Practice Address - Street 1:650 SE 9TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-5766
Practice Address - Country:US
Practice Address - Phone:786-806-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FLBRT-20-119418106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty