Provider Demographics
NPI:1780192195
Name:GONZALEZ, MILAIDA JUANA
Entity Type:Individual
Prefix:
First Name:MILAIDA
Middle Name:JUANA
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 1:2421 NW 10TH AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-4287
Mailing Address - Country:US
Mailing Address - Phone:347-806-9326
Mailing Address - Fax:
Practice Address - Street 1:2421 NW 10TH AVE APT 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-4287
Practice Address - Country:US
Practice Address - Phone:305-951-4957
Practice Address - Fax:305-901-1797
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician