Provider Demographics
NPI:1831832625
Name:CABAN-GONZALEZ, MILEICKA MARIA
Entity type:Individual
Prefix:
First Name:MILEICKA
Middle Name:MARIA
Last Name:CABAN-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 1:4608 GLENCREST LOOP
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34772-9014
Mailing Address - Country:US
Mailing Address - Phone:787-371-1211
Mailing Address - Fax:
Practice Address - Street 1:5449 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-1722
Practice Address - Country:US
Practice Address - Phone:407-734-1273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health