Provider Demographics
NPI:1699367581
Name:GONZALEZ ALVAREZ, ANIA CARIDAD
Entity Type:Individual
Prefix:
First Name:ANIA
Middle Name:CARIDAD
Last Name:GONZALEZ ALVAREZ
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 1:1911 SW 107TH AVE APT 1008
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7357
Mailing Address - Country:US
Mailing Address - Phone:786-372-2304
Mailing Address - Fax:
Practice Address - Street 1:1807 SW 107TH AVE APT 2202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7365
Practice Address - Country:US
Practice Address - Phone:786-372-2304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-14-4479106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician