Provider Demographics
NPI:1528716925
Name:GONZALEZ VAZQUEZ, MARILEE MARIA
Entity type:Individual
Prefix:
First Name:MARILEE
Middle Name:MARIA
Last Name:GONZALEZ VAZQUEZ
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 1:461 NW 107TH AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-3837
Mailing Address - Country:US
Mailing Address - Phone:786-444-2334
Mailing Address - Fax:
Practice Address - Street 1:461 NW 107TH AVE APT 103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-3837
Practice Address - Country:US
Practice Address - Phone:786-444-2334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician