Provider Demographics
NPI:1376087874
Name:BOYLE GONZALEZ, ODIN
Entity Type:Individual
Prefix:
First Name:ODIN
Middle Name:
Last Name:BOYLE GONZALEZ
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 1:10215 MARLIN RD
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7718
Mailing Address - Country:US
Mailing Address - Phone:786-372-3266
Mailing Address - Fax:
Practice Address - Street 1:10215 MARLIN RD
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7718
Practice Address - Country:US
Practice Address - Phone:786-372-3266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst