Provider Demographics
NPI:1992311153
Name:MORON GONZALEZ, ADIANEZ (RBT)
Entity type:Individual
Prefix:
First Name:ADIANEZ
Middle Name:
Last Name:MORON GONZALEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 W 41ST ST APT 204
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5947
Mailing Address - Country:US
Mailing Address - Phone:786-853-9333
Mailing Address - Fax:
Practice Address - Street 1:1290 W 41ST ST APT 204
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5947
Practice Address - Country:US
Practice Address - Phone:786-853-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-19-10041103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst