Provider Demographics
NPI:1780033472
Name:GONZALEZ, ALEIDA
Entity Type:Individual
Prefix:
First Name:ALEIDA
Middle Name:
Last Name:GONZALEZ
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 1:10909 W OCKEECHOBEE RD APT 201
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018
Mailing Address - Country:US
Mailing Address - Phone:786-985-5093
Mailing Address - Fax:
Practice Address - Street 1:10909 W OCKEECHOBEE RD UNIT 201
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018
Practice Address - Country:US
Practice Address - Phone:786-985-5093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1507241103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst