Provider Demographics
NPI:1588327399
Name:GONZALEZ, GABRIELLA KATHERINE-MARIE
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:KATHERINE-MARIE
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 1:8153 PATTERSON FOX DR APT 9104
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-6746
Mailing Address - Country:US
Mailing Address - Phone:407-715-2311
Mailing Address - Fax:
Practice Address - Street 1:7594 W SAND LAKE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5188
Practice Address - Country:US
Practice Address - Phone:800-875-1871
Practice Address - Fax:800-875-1871
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician