Provider Demographics
NPI:1821458787
Name:LOPEZ VITON, GONZALO YOEL
Entity Type:Individual
Prefix:MR
First Name:GONZALO
Middle Name:YOEL
Last Name:LOPEZ VITON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 SW 102ND AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4580
Mailing Address - Country:US
Mailing Address - Phone:786-316-6219
Mailing Address - Fax:
Practice Address - Street 1:14520 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-3132
Practice Address - Country:US
Practice Address - Phone:305-752-0208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst