Provider Demographics
NPI:1609224112
Name:FERNANDEZ GONZALEZ, CRISTOBALINA
Entity Type:Individual
Prefix:
First Name:CRISTOBALINA
Middle Name:
Last Name:FERNANDEZ 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 1:2141 SW 1ST ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1694
Mailing Address - Country:US
Mailing Address - Phone:305-644-6024
Mailing Address - Fax:
Practice Address - Street 1:2141 SW 1ST ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1694
Practice Address - Country:US
Practice Address - Phone:305-644-6024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-16-18335106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician