Provider Demographics
NPI:1407503444
Name:FERNANDEZ GONZALEZ, DIANELIS
Entity Type:Individual
Prefix:
First Name:DIANELIS
Middle Name:
Last Name:FERNANDEZ GONZALEZ
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 1:126 SIDONIA AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3350
Mailing Address - Country:US
Mailing Address - Phone:786-800-1530
Mailing Address - Fax:
Practice Address - Street 1:126 SIDONIA AVE APT 6
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3350
Practice Address - Country:US
Practice Address - Phone:786-800-1530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician