Provider Demographics
NPI:1154127322
Name:GONZALEZ, NEREIDA
Entity type:Individual
Prefix:
First Name:NEREIDA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7644 W 30TH LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-3825
Mailing Address - Country:US
Mailing Address - Phone:786-383-9907
Mailing Address - Fax:
Practice Address - Street 1:9999 NE 2ND AVE STE 219
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2345
Practice Address - Country:US
Practice Address - Phone:954-871-1119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician