Provider Demographics
NPI:1518733971
Name:GONZALEZ RODRIGUEZ, ANDY FELIX I
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:FELIX
Last Name:GONZALEZ RODRIGUEZ
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9621 SW 77TH AVE APT 205B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2653
Mailing Address - Country:US
Mailing Address - Phone:786-277-0837
Mailing Address - Fax:
Practice Address - Street 1:9621 SW 77TH AVE APT B25
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-2627
Practice Address - Country:US
Practice Address - Phone:786-790-0541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician