1750957551 NPI number — MRS. DAIMARELYS GONZALEZ RBT

Table of content: MRS. DAIMARELYS GONZALEZ RBT (NPI 1750957551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750957551 NPI number — MRS. DAIMARELYS GONZALEZ RBT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ
Provider First Name:
DAIMARELYS
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RBT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750957551
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14319 SW 169TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33177-2070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-208-3124
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8743 SW 9TH TER STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33174-3235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-244-9157
Provider Business Practice Location Address Fax Number:
786-332-4347
Provider Enumeration Date:
06/02/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 108591200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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