Provider Demographics
NPI:1184470890
Name:ESTRADA GONZALEZ, MARIA DE LURDES
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DE LURDES
Last Name:ESTRADA 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 1:14158 SW 145TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6786
Mailing Address - Country:US
Mailing Address - Phone:305-508-8564
Mailing Address - Fax:
Practice Address - Street 1:14158 SW 145TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6786
Practice Address - Country:US
Practice Address - Phone:305-508-8564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-338980106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician