Provider Demographics
NPI:1518520147
Name:GONZALEZ SANCHEZ, EDITH ARLENE
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:ARLENE
Last Name:GONZALEZ SANCHEZ
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 1:13036 WATERFORD WOOD CIR APT 304
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6053
Mailing Address - Country:US
Mailing Address - Phone:787-449-0419
Mailing Address - Fax:
Practice Address - Street 1:13036 WATERFORD WOOD CIR APT 304
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-6053
Practice Address - Country:US
Practice Address - Phone:787-449-0419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10387078OtherCMS ENTERPRISE