Provider Demographics
NPI:1366025983
Name:GONZALEZ RODRIGUEZ, PABLO FELIX
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:FELIX
Last Name:GONZALEZ RODRIGUEZ
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 1:6849 NW 173RD DR APT 202F
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5569
Mailing Address - Country:US
Mailing Address - Phone:786-326-3068
Mailing Address - Fax:
Practice Address - Street 1:6849 NW 173RD DR APT 202F
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5569
Practice Address - Country:US
Practice Address - Phone:786-326-3068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-02
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL20-143902106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty