Provider Demographics
NPI:1720883739
Name:PEDRERO GONZALEZ, DAYLIN DE LA CARIDAD
Entity type:Individual
Prefix:
First Name:DAYLIN
Middle Name:DE LA CARIDAD
Last Name:PEDRERO GONZALEZ
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 1:2224 OASIS PALM CIR APT 207
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-3469
Mailing Address - Country:US
Mailing Address - Phone:239-674-9310
Mailing Address - Fax:
Practice Address - Street 1:130 LEE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6120
Practice Address - Country:US
Practice Address - Phone:239-674-9310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB791641106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty