Provider Demographics
NPI:1023849445
Name:GONZALEZ, MILADYS
Entity type:Individual
Prefix:
First Name:MILADYS
Middle Name:
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 1:14767 PINNACLE PL
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-4101
Mailing Address - Country:US
Mailing Address - Phone:305-360-5267
Mailing Address - Fax:
Practice Address - Street 1:14767 PINNACLE PL
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-4101
Practice Address - Country:US
Practice Address - Phone:305-360-5267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
24-362577106S00000X
FL24-362577106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician