Provider Demographics
NPI:1245013523
Name:REMIS GONZALEZ, YUDEIQUIS (RBT)
Entity type:Individual
Prefix:
First Name:YUDEIQUIS
Middle Name:
Last Name:REMIS GONZALEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 SE 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33035-2262
Mailing Address - Country:US
Mailing Address - Phone:305-890-8918
Mailing Address - Fax:
Practice Address - Street 1:2102 SE 17TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33035-2262
Practice Address - Country:US
Practice Address - Phone:305-890-8918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-140987106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician