Provider Demographics
NPI:1750957551
Name:GONZALEZ, DAIMARELYS (RBT)
Entity type:Individual
Prefix:MRS
First Name:DAIMARELYS
Middle Name:
Last Name: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 1:14319 SW 169TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-2070
Mailing Address - Country:US
Mailing Address - Phone:786-208-3124
Mailing Address - Fax:
Practice Address - Street 1:8743 SW 9TH TER STE 2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-3235
Practice Address - Country:US
Practice Address - Phone:305-244-9157
Practice Address - Fax:786-332-4347
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108591200Medicaid