Provider Demographics
NPI:1629849849
Name:MIERES GONZALEZ, EDUARDO (HHA, RBT)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:MIERES GONZALEZ
Suffix:
Gender:M
Credentials:HHA, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14614 SW 174TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-6642
Mailing Address - Country:US
Mailing Address - Phone:786-614-4846
Mailing Address - Fax:
Practice Address - Street 1:13195 SW 134TH ST STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4585
Practice Address - Country:US
Practice Address - Phone:786-227-6830
Practice Address - Fax:786-524-2413
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-136895106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician