Provider Demographics
NPI:1891671640
Name:GONZALEZ FERNANDEZ, PEDRO
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:GONZALEZ FERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 W 46TH ST APT 515
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2870
Mailing Address - Country:US
Mailing Address - Phone:786-387-2375
Mailing Address - Fax:
Practice Address - Street 1:9102 NW 148TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33018-7314
Practice Address - Country:US
Practice Address - Phone:305-445-0032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician