Provider Demographics
NPI:1255036778
Name:BARRIOS GONZALEZ, RUTH L
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:L
Last Name:BARRIOS 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 1:17760 NW 67TH AVE APT 810
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5811
Mailing Address - Country:US
Mailing Address - Phone:786-707-5543
Mailing Address - Fax:
Practice Address - Street 1:17760 NW 67TH AVE APT 810
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5811
Practice Address - Country:US
Practice Address - Phone:786-707-5543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT20-127043106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician