Provider Demographics
NPI:1225541394
Name:GONZALEZ SALAZAR, VICTOR DAVID
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:DAVID
Last Name:GONZALEZ SALAZAR
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 1:100 NW 87TH AVE APT E104
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4519
Mailing Address - Country:US
Mailing Address - Phone:786-732-0508
Mailing Address - Fax:
Practice Address - Street 1:100 NW 87TH AVE APT E104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4519
Practice Address - Country:US
Practice Address - Phone:786-732-0508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL0-23-14259106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician