Provider Demographics
NPI:1134912520
Name:DE LA NUEZ, GRETHEL
Entity type:Individual
Prefix:
First Name:GRETHEL
Middle Name:
Last Name:DE LA NUEZ
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 1:1538 NE 8TH ST APT 207
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-4678
Mailing Address - Country:US
Mailing Address - Phone:786-397-4914
Mailing Address - Fax:
Practice Address - Street 1:1538 NE 8TH ST APT 207
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-4678
Practice Address - Country:US
Practice Address - Phone:786-397-4914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-437805106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician