Provider Demographics
NPI:1699485417
Name:GONZALEZ, MONIA ENSEQUIA
Entity type:Individual
Prefix:MS
First Name:MONIA
Middle Name:ENSEQUIA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MONIA
Other - Middle Name:ENSEQUIA
Other - Last Name:DIAMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:458 CAMBER AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55075-2836
Mailing Address - Country:US
Mailing Address - Phone:651-515-9830
Mailing Address - Fax:
Practice Address - Street 1:731 BIELENBERG DR STE 102-104
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1700
Practice Address - Country:US
Practice Address - Phone:612-439-4653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician