MEDICARE: ORIALYS GONZALEZ

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
2	103K00000X	Behavior Analyst	1-21-56984	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	:	1093361396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ORIALYS GONZALEZ

Provider Business Mailing Address
First Line	:	4022 CHIQUITA BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-5646
Country	:	US
Telephone Number	:	786-419-1395
Fax Number	:

Provider Business Practice Location Address
First Line	:	4022 CHIQUITA BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-5646
Country	:	US
Telephone Number	:	239-549-3201
Fax Number	:

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

Provider Enumeration Date	:	08/13/2019
Last Update Date	:	02/03/2022

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Directions to “ ORIALYS GONZALEZ ” Practice Location

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