Provider Demographics
NPI:1942878376
Name:GONZALEZ FLEITAS, ADA (CBHCM, RN)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:
Last Name:GONZALEZ FLEITAS
Suffix:
Gender:F
Credentials:CBHCM, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BAYVIEW DR APT 703
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4745
Mailing Address - Country:US
Mailing Address - Phone:813-270-3865
Mailing Address - Fax:
Practice Address - Street 1:14411 COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1596
Practice Address - Country:US
Practice Address - Phone:754-234-4331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-13
Last Update Date:2021-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9519458163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse