Provider Demographics
NPI:1962071035
Name:GORROCHATEGUI, AMAYA
Entity type:Individual
Prefix:
First Name:AMAYA
Middle Name:
Last Name:GORROCHATEGUI
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 1:745 NW 133RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-1867
Mailing Address - Country:US
Mailing Address - Phone:786-486-9952
Mailing Address - Fax:
Practice Address - Street 1:12227 SW 129TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6441
Practice Address - Country:US
Practice Address - Phone:305-255-6203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician