Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | FL |
NPI | 1003354549 |
---|---|
Provider Name | Midiala Gonzalez |
First Address | Hialeah, FL 33013-2860 |
Second Address | Hialeah, FL 33013-2860 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2017 |
Last Update Date | 04/02/2017 |