Provider Demographics
NPI:1972169662
Name:GONZALEZ, REINALDO (BS)
Entity Type:Individual
Prefix:
First Name:REINALDO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 S RIO GRANDE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4650
Mailing Address - Country:US
Mailing Address - Phone:407-982-7718
Mailing Address - Fax:
Practice Address - Street 1:6000 S RIO GRANDE AVE STE 102
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4650
Practice Address - Country:US
Practice Address - Phone:407-982-7718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Single Specialty