Healthcare Provider Details

I. General information

NPI: 1427577675
Provider Name (Legal Business Name): GLEIDYS GONZALEZ SANTANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13570 SW 40TH LN
MIAMI FL
33175-3260
US

IV. Provider business mailing address

13570 SW 40TH LN
MIAMI FL
33175-3260
US

V. Phone/Fax

Practice location:
  • Phone: 786-768-9985
  • Fax:
Mailing address:
  • Phone: 786-768-9985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH16682
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberMH16682
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: