Provider Demographics
NPI:1942408828
Name:GONZALEZ, ILIANA STENIE
Entity Type:Individual
Prefix:
First Name:ILIANA
Middle Name:STENIE
Last Name: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 1:508 SE WHITMORE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-4560
Mailing Address - Country:US
Mailing Address - Phone:772-785-7110
Mailing Address - Fax:772-785-7110
Practice Address - Street 1:508 SE WHITMORE DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-4560
Practice Address - Country:US
Practice Address - Phone:772-785-7110
Practice Address - Fax:772-785-7110
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child