Provider Demographics
NPI:1619481074
Name:GONZALEZ DIAZ, YAMELA
Entity Type:Individual
Prefix:
First Name:YAMELA
Middle Name:
Last Name:GONZALEZ DIAZ
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 1:6224 SW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-2857
Mailing Address - Country:US
Mailing Address - Phone:786-521-6920
Mailing Address - Fax:
Practice Address - Street 1:3350 SW 148TH AVE
Practice Address - Street 2:STE 110
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3237
Practice Address - Country:US
Practice Address - Phone:954-734-2737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician