Provider Demographics
NPI:1770158842
Name:RUIZ GONZALEZ, ANARA
Entity type:Individual
Prefix:
First Name:ANARA
Middle Name:
Last Name:RUIZ 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 1:6961 W 14TH CT APT 107
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4569
Mailing Address - Country:US
Mailing Address - Phone:305-200-4255
Mailing Address - Fax:
Practice Address - Street 1:91831 OVERSEAS HWY UNIT 11
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2647
Practice Address - Country:US
Practice Address - Phone:305-998-4949
Practice Address - Fax:305-998-4680
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-117790106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106571900Medicaid