MEDICARE: EVELIN BEATRIZ GONZALEZ AGUILAR

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-23-276229	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073290722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELIN BEATRIZ GONZALEZ AGUILAR

Provider Business Mailing Address
First Line	:	951 SW 100TH TER
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33025-0906
Country	:	US
Telephone Number	:	754-816-0185
Fax Number	:

Provider Business Practice Location Address
First Line	:	5100 W COPANS RD STE 300
Second Line	:
City	:	MARGATE
State	:	FL
Zip	:	33063-7700
Country	:	US
Telephone Number	:	954-825-3317
Fax Number	:

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

Provider Enumeration Date	:	07/03/2023
Last Update Date	:	07/03/2023

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