Provider Demographics
NPI:1720819774
Name:GONZALEZ ALVAREZ, VICTOR
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:GONZALEZ ALVAREZ
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 1:20613 SW 93RD AVE
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-3236
Mailing Address - Country:US
Mailing Address - Phone:813-217-1789
Mailing Address - Fax:
Practice Address - Street 1:20613 SW 93RD AVE
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-3236
Practice Address - Country:US
Practice Address - Phone:813-217-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-364898106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician