Provider Demographics
NPI:1275132227
Name:GONZALEZ AGRAMONTE, ANGELA AIXA (RBT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:AIXA
Last Name:GONZALEZ AGRAMONTE
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 1:5540 SW 163RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5112
Mailing Address - Country:US
Mailing Address - Phone:786-717-0376
Mailing Address - Fax:
Practice Address - Street 1:5540 SW 163RD CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5112
Practice Address - Country:US
Practice Address - Phone:786-717-0376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-129353106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician