Provider Demographics
NPI:1851182703
Name:GONZALEZ DIAZ, SULEIDY
Entity type:Individual
Prefix:
First Name:SULEIDY
Middle Name:
Last Name:GONZALEZ DIAZ
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 1:7460 SW 107TH AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2988
Mailing Address - Country:US
Mailing Address - Phone:786-641-2278
Mailing Address - Fax:
Practice Address - Street 1:7460 SW 107TH AVE APT 305
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2988
Practice Address - Country:US
Practice Address - Phone:786-641-2278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-413687106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician