Provider Demographics
NPI:1376069161
Name:GONZALEZ CEBALLO, DAMARYS
Entity Type:Individual
Prefix:
First Name:DAMARYS
Middle Name:
Last Name:GONZALEZ CEBALLO
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 1:2500 NW 79TH AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1075
Mailing Address - Country:US
Mailing Address - Phone:305-591-7898
Mailing Address - Fax:
Practice Address - Street 1:7687 NW 178TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-6163
Practice Address - Country:US
Practice Address - Phone:786-356-7863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician