Provider Demographics
NPI:1629692959
Name:GONZALEZ COYRA, ARELIS SILVIA (RBT)
Entity Type:Individual
Prefix:
First Name:ARELIS
Middle Name:SILVIA
Last Name:GONZALEZ COYRA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5751 NW 114TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6609
Mailing Address - Country:US
Mailing Address - Phone:786-357-8461
Mailing Address - Fax:
Practice Address - Street 1:5751 NW 114TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6609
Practice Address - Country:US
Practice Address - Phone:786-357-8461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-23-66679103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103159600Medicaid