Provider Demographics
NPI:1811570435
Name:GRAU GONZALEZ, GUIANEYA
Entity Type:Individual
Prefix:
First Name:GUIANEYA
Middle Name:
Last Name:GRAU 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 1:6617 DAHLIA DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-4910
Mailing Address - Country:US
Mailing Address - Phone:786-212-7637
Mailing Address - Fax:
Practice Address - Street 1:403 SW 103RD AVE APT 304
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-1881
Practice Address - Country:US
Practice Address - Phone:954-478-4746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-02
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
G625280707570106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician