Healthcare Provider Details

I. General information

NPI: 1184639569
Provider Name (Legal Business Name): VIVIAN D.J. GONZALEZ-DIAZ PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3271 NW 7TH ST SUITE #203
MIAMI FL
33125-4141
US

IV. Provider business mailing address

PO BOX 347604
CORAL GABLES FL
33234-7604
US

V. Phone/Fax

Practice location:
  • Phone: 786-220-6902
  • Fax: 866-726-0526
Mailing address:
  • Phone: 305-984-8422
  • Fax: 305-836-4722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY5395
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY5395
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: