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NPI Code Detail

MEDICARE: ANNETTE GONZALEZ

MEDICARE: ANNETTE 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
1106S00000XBehavior TechnicianRBT-24-335790FL

General Provider Information

NPI Number : 1134974470
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNETTE GONZALEZ
Provider Business Mailing Address
First Line : 5471 W 10TH LN
Second Line :
City : HIALEAH
State : FL
Zip : 33012-2463
Country : US
Telephone Number : 305-742-7015
Fax Number :
Provider Business Practice Location Address
First Line : 5471 W 10TH LN
Second Line :
City : HIALEAH
State : FL
Zip : 33012-2463
Country : US
Telephone Number : 305-742-7015
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2024
Last Update Date : 04/19/2024

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Directions to “ ANNETTE GONZALEZ ” Practice Location

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