Provider Demographics
NPI:1215629910
Name:MUNOZ DE CONTRERAS, MARY GABRIELY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:GABRIELY
Last Name:MUNOZ DE CONTRERAS
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 1:4336 RENLY LN
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5514
Mailing Address - Country:US
Mailing Address - Phone:407-929-1956
Mailing Address - Fax:
Practice Address - Street 1:4336 RENLY LN
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5514
Practice Address - Country:US
Practice Address - Phone:407-929-1956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician