Provider Demographics
NPI:1629834437
Name:GOMEZ FRANQUEIRO, MAIDELYS DE LA CARIDAD
Entity Type:Individual
Prefix:
First Name:MAIDELYS
Middle Name:DE LA CARIDAD
Last Name:GOMEZ FRANQUEIRO
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 1:7439 W 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1706
Mailing Address - Country:US
Mailing Address - Phone:305-572-5213
Mailing Address - Fax:
Practice Address - Street 1:4801 S UNIVERSITY DR STE 130
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3832
Practice Address - Country:US
Practice Address - Phone:954-592-8659
Practice Address - Fax:561-516-8183
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-306611106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician