Provider Demographics
NPI:1841749942
Name:EXPOSITO GONZALEZ, LADYS LAY
Entity Type:Individual
Prefix:
First Name:LADYS
Middle Name:LAY
Last Name:EXPOSITO 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 1:267 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-2721
Mailing Address - Country:US
Mailing Address - Phone:305-609-7520
Mailing Address - Fax:
Practice Address - Street 1:267 E 19TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-2721
Practice Address - Country:US
Practice Address - Phone:305-609-7520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician