Provider Demographics
NPI:1225550171
Name:GONZALEZ CABALLERO, SANDRA ALINA
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ALINA
Last Name:GONZALEZ CABALLERO
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 1:11580 SW 30TH ST UNIT 308
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7853
Mailing Address - Country:US
Mailing Address - Phone:786-792-2873
Mailing Address - Fax:
Practice Address - Street 1:11580 SW 30TH ST UNIT 308
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-7853
Practice Address - Country:US
Practice Address - Phone:786-792-2873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18-73121106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician