Provider Demographics
NPI:1891438123
Name:GONZALEZ RADA, LUISANA
Entity Type:Individual
Prefix:
First Name:LUISANA
Middle Name:
Last Name:GONZALEZ RADA
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 1:16836 SW 137TH AVE APT 323
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-2409
Mailing Address - Country:US
Mailing Address - Phone:754-304-4333
Mailing Address - Fax:
Practice Address - Street 1:16836 SW 137TH AVE APT 323
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-2409
Practice Address - Country:US
Practice Address - Phone:754-304-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician