Provider Demographics
NPI:1902618911
Name:GONZALEZ, ADELINA NICOLE
Entity type:Individual
Prefix:
First Name:ADELINA
Middle Name:NICOLE
Last Name: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 1:18505 CAMINO REAL # A
Mailing Address - Street 2:
Mailing Address - City:DALE
Mailing Address - State:TX
Mailing Address - Zip Code:78616-3196
Mailing Address - Country:US
Mailing Address - Phone:512-738-7903
Mailing Address - Fax:
Practice Address - Street 1:601 S LAKE DESTINY RD STE MAITLAND
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7226
Practice Address - Country:US
Practice Address - Phone:737-346-3334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-25
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician