Provider Demographics
NPI:1073010393
Name:GONZALEZ PEREZ, DAIRANELYS
Entity type:Individual
Prefix:
First Name:DAIRANELYS
Middle Name:
Last Name:GONZALEZ PEREZ
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 1:24885 SW 119TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-4316
Mailing Address - Country:US
Mailing Address - Phone:786-660-2961
Mailing Address - Fax:
Practice Address - Street 1:24885 SW 119TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-4316
Practice Address - Country:US
Practice Address - Phone:786-660-2961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician