Provider Demographics
NPI:1477045383
Name:GONZALEZ, NELIDA IVETTE
Entity Type:Individual
Prefix:MR
First Name:NELIDA
Middle Name:IVETTE
Last Name: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 1:135 ANTHONY DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773
Mailing Address - Country:US
Mailing Address - Phone:407-780-5760
Mailing Address - Fax:
Practice Address - Street 1:BRIGHTER JOURNEYS LLC
Practice Address - Street 2:8600 SAND LAKE SHORES DR
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836
Practice Address - Country:US
Practice Address - Phone:407-780-5760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician