Provider Demographics
NPI:1225916414
Name:BLANCO GONZALEZ, ANNIA
Entity type:Individual
Prefix:
First Name:ANNIA
Middle Name:
Last Name:BLANCO 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 1:615 W 68TH ST APT 201
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4881
Mailing Address - Country:US
Mailing Address - Phone:786-219-6781
Mailing Address - Fax:
Practice Address - Street 1:615 W 68TH ST APT 201
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4881
Practice Address - Country:US
Practice Address - Phone:786-219-6781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-437409106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician