Provider Demographics
NPI:1609756113
Name:GONZALEZ FERNANDEZ, MIREIDY
Entity type:Individual
Prefix:
First Name:MIREIDY
Middle Name:
Last Name:GONZALEZ FERNANDEZ
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 1:6830 SW 132ND AVE
Mailing Address - Street 2:
Mailing Address - City:KENDALL
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2382
Mailing Address - Country:US
Mailing Address - Phone:786-424-6598
Mailing Address - Fax:
Practice Address - Street 1:6830 SW 132ND AVE
Practice Address - Street 2:
Practice Address - City:KENDALL
Practice Address - State:FL
Practice Address - Zip Code:33183-2382
Practice Address - Country:US
Practice Address - Phone:786-424-6598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician