Provider Demographics
NPI:1396377867
Name:GONZALEZ NADER, ISABELA JESUS
Entity Type:Individual
Prefix:
First Name:ISABELA
Middle Name:JESUS
Last Name:GONZALEZ NADER
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 1:12271 SW 143RD LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6021
Mailing Address - Country:US
Mailing Address - Phone:305-850-0188
Mailing Address - Fax:
Practice Address - Street 1:12271 SW 143RD LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6021
Practice Address - Country:US
Practice Address - Phone:305-850-0188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-108865106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician