Provider Demographics
NPI:1912599655
Name:GONZALEZ DEL RISCO, DANIELLYS
Entity Type:Individual
Prefix:
First Name:DANIELLYS
Middle Name:
Last Name:GONZALEZ DEL RISCO
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 1:11201 SW 55TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3100
Mailing Address - Country:US
Mailing Address - Phone:786-317-2083
Mailing Address - Fax:
Practice Address - Street 1:11201 SW 55TH ST UNIT 201
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-3107
Practice Address - Country:US
Practice Address - Phone:786-317-2083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst