Provider Demographics
NPI:1558862201
Name:GONZALEZ, DARIAM LAZARO
Entity Type:Individual
Prefix:
First Name:DARIAM
Middle Name:LAZARO
Last Name:GONZALEZ
Suffix:
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 1:8373 LAKE DR APT 501
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7740
Mailing Address - Country:US
Mailing Address - Phone:305-562-8557
Mailing Address - Fax:305-742-2190
Practice Address - Street 1:8373 LAKE DR APT 501
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-7740
Practice Address - Country:US
Practice Address - Phone:305-562-8557
Practice Address - Fax:305-742-2190
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician