Provider Demographics
NPI:1699123273
Name:GONZALEZ VEGA, RAIZA
Entity type:Individual
Prefix:
First Name:RAIZA
Middle Name:
Last Name:GONZALEZ VEGA
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 1:8927 SW 40TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-5305
Mailing Address - Country:US
Mailing Address - Phone:786-516-0416
Mailing Address - Fax:
Practice Address - Street 1:8927 SW 40TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-5305
Practice Address - Country:US
Practice Address - Phone:786-516-0416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician