Provider Demographics
NPI:1194434654
Name:PERDOMO GONZALEZ, DANIELA (RBT)
Entity type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:PERDOMO GONZALEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1469 W 44TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7662
Mailing Address - Country:US
Mailing Address - Phone:305-873-7747
Mailing Address - Fax:
Practice Address - Street 1:1469 W 44TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7662
Practice Address - Country:US
Practice Address - Phone:305-873-7747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22243857106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician