Provider Demographics
NPI:1497412837
Name:GONZALEZ, MELANIE C
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:C
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 1:4325 SW 74TH WAY
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-3018
Mailing Address - Country:US
Mailing Address - Phone:954-616-7368
Mailing Address - Fax:
Practice Address - Street 1:4325 SW 74TH WAY
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-3018
Practice Address - Country:US
Practice Address - Phone:954-616-7368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician