Provider Demographics
NPI:1932691185
Name:GONZALEZ JARAMILLO, SULEIDA
Entity Type:Individual
Prefix:
First Name:SULEIDA
Middle Name:
Last Name:GONZALEZ JARAMILLO
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 1:7123 W 4TH WAY
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4961
Mailing Address - Country:US
Mailing Address - Phone:786-372-3625
Mailing Address - Fax:
Practice Address - Street 1:7123 W 4TH WAY
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4961
Practice Address - Country:US
Practice Address - Phone:786-372-3625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst