Provider Demographics
NPI:1598575227
Name:GONZALEZ DE LA CRUZ, ANGEL D
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:D
Last Name:GONZALEZ DE LA CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10115 W SUNRISE BLVD APT 206
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5669
Mailing Address - Country:US
Mailing Address - Phone:754-296-6492
Mailing Address - Fax:
Practice Address - Street 1:10115 W SUNRISE BLVD APT 206
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5669
Practice Address - Country:US
Practice Address - Phone:754-296-6492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician