Provider Demographics
NPI:1295416246
Name:GONZALEZ VARGAS, DANIELA
Entity type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:GONZALEZ VARGAS
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 1:15002 ROYAL PALM CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2535
Mailing Address - Country:US
Mailing Address - Phone:786-288-9882
Mailing Address - Fax:
Practice Address - Street 1:15002 ROYAL PALM CT
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2535
Practice Address - Country:US
Practice Address - Phone:786-288-9882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-321725106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician