Provider Demographics
NPI:1497418016
Name:FREITAS GONZALEZ, TANIA ANDREINA
Entity Type:Individual
Prefix:
First Name:TANIA ANDREINA
Middle Name:
Last Name:FREITAS 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 1:1026 NW 87TH AVE APT 307
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2448
Mailing Address - Country:US
Mailing Address - Phone:703-728-4648
Mailing Address - Fax:
Practice Address - Street 1:1026 NW 87TH AVE APT 307
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-2448
Practice Address - Country:US
Practice Address - Phone:703-728-4648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
FLRBT-21-189642106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician