Provider Demographics
NPI:1124847272
Name:MIGOYO GOMEZ DE CEDRON, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MIGOYO GOMEZ DE CEDRON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11881 SW 35TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3103
Mailing Address - Country:US
Mailing Address - Phone:786-316-8522
Mailing Address - Fax:
Practice Address - Street 1:11881 SW 35TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3103
Practice Address - Country:US
Practice Address - Phone:786-316-8522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician