Provider Demographics
NPI:1437680857
Name:SALAZAR GONZALEZ, ALFREDO
Entity type:Individual
Prefix:
First Name:ALFREDO
Middle Name:
Last Name:SALAZAR GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6528 SW 158TH PASS
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-3663
Mailing Address - Country:US
Mailing Address - Phone:786-781-2221
Mailing Address - Fax:305-901-1797
Practice Address - Street 1:6528 SW 158TH PASS
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-3663
Practice Address - Country:US
Practice Address - Phone:786-781-2221
Practice Address - Fax:305-901-1797
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-20-11348106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst