Provider Demographics
NPI:1346900263
Name:GONZALEZ URRA, ANA IRIS (RBT)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:IRIS
Last Name:GONZALEZ URRA
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 1:4201 SW HAGAPLAN ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-6583
Mailing Address - Country:US
Mailing Address - Phone:561-480-5351
Mailing Address - Fax:
Practice Address - Street 1:1600 SW SYLVESTER LN
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-3605
Practice Address - Country:US
Practice Address - Phone:772-333-4411
Practice Address - Fax:772-353-5951
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-147681106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician