Provider Demographics
NPI:1225548811
Name:GONZALEZ, YUDISLEIDY DE LA CARIDAD
Entity type:Individual
Prefix:
First Name:YUDISLEIDY
Middle Name:DE LA CARIDAD
Last Name:GONZALEZ
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 1:3071 NW 100TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-2070
Mailing Address - Country:US
Mailing Address - Phone:786-801-4944
Mailing Address - Fax:
Practice Address - Street 1:7600 W 20TH AVE STE 108
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1895
Practice Address - Country:US
Practice Address - Phone:786-534-5482
Practice Address - Fax:305-503-7208
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst