Healthcare Provider Details

I. General information

NPI: 1477105740
Provider Name (Legal Business Name): YADITZA SIGLER GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10818 SW 147TH PL
MIAMI FL
33196-2485
US

IV. Provider business mailing address

10818 SW 147TH PL
MIAMI FL
33196-2485
US

V. Phone/Fax

Practice location:
  • Phone: 786-319-3852
  • Fax:
Mailing address:
  • Phone: 786-319-3852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11039995
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: