Provider Demographics
NPI:1356010474
Name:GONZALEZ TORRES, DIADENYS (REGISTERED BEHAVIOR)
Entity Type:Individual
Prefix:
First Name:DIADENYS
Middle Name:
Last Name:GONZALEZ TORRES
Suffix:
Gender:F
Credentials:REGISTERED BEHAVIOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 NW 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-6410
Mailing Address - Country:US
Mailing Address - Phone:786-641-8346
Mailing Address - Fax:
Practice Address - Street 1:2902 NW 30TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-6410
Practice Address - Country:US
Practice Address - Phone:786-641-8346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20116913106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106220100Medicaid