Provider Demographics
NPI:1588453922
Name:GONZALEZ AVILA, LISSANDRA
Entity type:Individual
Prefix:
First Name:LISSANDRA
Middle Name:
Last Name:GONZALEZ AVILA
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 1:3606 NW 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-3160
Mailing Address - Country:US
Mailing Address - Phone:786-835-9728
Mailing Address - Fax:
Practice Address - Street 1:3606 NW 5TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-3160
Practice Address - Country:US
Practice Address - Phone:786-835-9728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician