Provider Demographics
NPI:1093527582
Name:GONZALEZ GOMEZ, MINDRAGUIZ
Entity type:Individual
Prefix:MRS
First Name:MINDRAGUIZ
Middle Name:
Last Name:GONZALEZ GOMEZ
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 1:240 W 68TH ST APT 101
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5391
Mailing Address - Country:US
Mailing Address - Phone:786-244-1760
Mailing Address - Fax:
Practice Address - Street 1:240 W 68TH ST APT 101
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-5391
Practice Address - Country:US
Practice Address - Phone:786-244-1760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician