Provider Demographics
NPI:1407391568
Name:GONZALEZ COUZO, DORKA
Entity Type:Individual
Prefix:
First Name:DORKA
Middle Name:
Last Name:GONZALEZ COUZO
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 1:7680 W 14TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-3302
Mailing Address - Country:US
Mailing Address - Phone:786-212-1008
Mailing Address - Fax:786-334-5826
Practice Address - Street 1:7680 W 14TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-3302
Practice Address - Country:US
Practice Address - Phone:786-212-1008
Practice Address - Fax:786-334-5826
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician