Most Relevant Information
Provider Data
| NPI Number: | 1003354549 |
| Provider Name: | MIDIALA GONZALEZ |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/04/2017 |
| Last Updated: | 02/04/2017 |
Provider Practice Location
880 E 40TH ST APT 1
HIALEAH
FL
330132860
Practice Location Phone/Fax
| Phone: | 7867196378 |
| Fax: |
Provider Mailing Location
880 E 40TH ST APT 1
HIALEAH
FL
330132860
Provider Mailing Phone/Fax
| Phone: | 7867196378 |
| Fax: |