MEDICARE: MISS MARIELA GONZALEZ VALE RBT-24-379623

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-24-379623

General Provider Information

NPI Number	:	1023835964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARIELA GONZALEZ VALE RBT-24-379623

Provider Business Mailing Address
First Line	:	1629 NW NORTH RIVER DR APT 501
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-2638
Country	:	US
Telephone Number	:	786-872-1483
Fax Number	:

Provider Business Practice Location Address
First Line	:	1629 NW NORTH RIVER DR APT 501
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-2638
Country	:	US
Telephone Number	:	786-872-1483
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2024
Last Update Date	:	09/23/2024

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