Provider Demographics
NPI:1821899527
Name:GONZALEZ HERNANDEZ, MARIELYS
Entity type:Individual
Prefix:
First Name:MARIELYS
Middle Name:
Last Name:GONZALEZ HERNANDEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1461 SW 124TH CT APT C
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-2359
Mailing Address - Country:US
Mailing Address - Phone:786-792-7936
Mailing Address - Fax:
Practice Address - Street 1:1461 SW 124TH CT APT C
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-2359
Practice Address - Country:US
Practice Address - Phone:786-792-7936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM.0104168171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator