Provider Demographics
NPI:1851988174
Name:GONZALEZ RODRIGUEZ, DISSUE (RBT)
Entity Type:Individual
Prefix:
First Name:DISSUE
Middle Name:
Last Name:GONZALEZ RODRIGUEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 NW 36TH ST APT 905
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-5017
Mailing Address - Country:US
Mailing Address - Phone:239-645-9604
Mailing Address - Fax:
Practice Address - Street 1:27 W 28TH ST APT 9
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-1758
Practice Address - Country:US
Practice Address - Phone:239-645-9604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-118745106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician