Provider Demographics
NPI:1972122026
Name:CUELLAR GONZALEZ, ARLENIS
Entity Type:Individual
Prefix:MS
First Name:ARLENIS
Middle Name:
Last Name:CUELLAR 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 1:12130 SW 41ST DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3543
Mailing Address - Country:US
Mailing Address - Phone:305-497-2365
Mailing Address - Fax:
Practice Address - Street 1:12130 SW 41ST DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3543
Practice Address - Country:US
Practice Address - Phone:305-497-2365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-75532106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104952000Medicaid