Provider Demographics
NPI:1760189849
Name:REGUERA GONZALEZ, ANA MARIA (RBT)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:MARIA
Last Name:REGUERA GONZALEZ
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 1:4733 W WATERS AVE APT 1613
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1462
Mailing Address - Country:US
Mailing Address - Phone:813-483-9960
Mailing Address - Fax:
Practice Address - Street 1:4733 W WATERS AVE APT 1613
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1462
Practice Address - Country:US
Practice Address - Phone:813-483-9960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22-229964106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty