Provider Demographics
NPI:1982302139
Name:GONZALEZ GONZALEZ, ANAMARYS
Entity Type:Individual
Prefix:
First Name:ANAMARYS
Middle Name:
Last Name:GONZALEZ 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 1:10281 SW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7419
Mailing Address - Country:US
Mailing Address - Phone:786-717-0805
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:786-534-6915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-258929106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician