Provider Demographics
NPI:1841014164
Name:SOSA GONZALEZ, ANIA YUDIHT
Entity type:Individual
Prefix:MRS
First Name:ANIA
Middle Name:YUDIHT
Last Name:SOSA 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 1:129 E BEACON RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-2603
Mailing Address - Country:US
Mailing Address - Phone:786-806-1894
Mailing Address - Fax:
Practice Address - Street 1:129 E BEACON RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-2603
Practice Address - Country:US
Practice Address - Phone:786-806-1894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-361490106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty