Provider Demographics
NPI:1558252262
Name:GONZALEZ, ODALYS
Entity type:Individual
Prefix:MRS
First Name:ODALYS
Middle Name:
Last Name: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 1:2311 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4046
Mailing Address - Country:US
Mailing Address - Phone:929-268-3324
Mailing Address - Fax:
Practice Address - Street 1:3130 GRAND CONCOURSE APT 6P
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-1231
Practice Address - Country:US
Practice Address - Phone:646-764-4761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-10
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator