Provider Demographics
NPI:1356194534
Name:GONZALEZ, ANDRO M (CBHCM)
Entity type:Individual
Prefix:MR
First Name:ANDRO
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 SW 142ND PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-3203
Mailing Address - Country:US
Mailing Address - Phone:786-942-9679
Mailing Address - Fax:
Practice Address - Street 1:1171 SW 142ND PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-3203
Practice Address - Country:US
Practice Address - Phone:786-942-9679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator