Provider Demographics
NPI:1649753484
Name:GONZALEZ FERNANDEZ, ELIZABETH DEL CARMEN
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DEL CARMEN
Last Name:GONZALEZ FERNANDEZ
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 1:13273 SW 272ND ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8593
Mailing Address - Country:US
Mailing Address - Phone:786-316-5860
Mailing Address - Fax:
Practice Address - Street 1:13273 SW 272ND ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8593
Practice Address - Country:US
Practice Address - Phone:786-316-5860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No251B00000XAgenciesCase Management