Provider Demographics
NPI:1851949424
Name:CHIRINO GONZALEZ, ESTELA
Entity Type:Individual
Prefix:
First Name:ESTELA
Middle Name:
Last Name:CHIRINO 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 1:11501 NW 2ND ST APT 107
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4950
Mailing Address - Country:US
Mailing Address - Phone:786-237-9568
Mailing Address - Fax:
Practice Address - Street 1:11501 NW 2ND ST APT 107
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4950
Practice Address - Country:US
Practice Address - Phone:786-237-9568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-19-92238106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician