Provider Demographics
NPI:1104446061
Name:GONZALEZ, LEILANI (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:
First Name:LEILANI
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30820 SW 190TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-3729
Mailing Address - Country:US
Mailing Address - Phone:305-562-9327
Mailing Address - Fax:
Practice Address - Street 1:30820 SW 190TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-3729
Practice Address - Country:US
Practice Address - Phone:305-562-9327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician