MEDICARE: WILFREDO MORALES 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	171M00000X	Case Manager/Care Coordinator

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	:	1376067108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILFREDO MORALES GONZALEZ

Provider Business Mailing Address
First Line	:	9999 NE 2ND AVE STE 203
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-2345
Country	:	US
Telephone Number	:	786-580-5131
Fax Number	:	786-580-5149

Provider Business Practice Location Address
First Line	:	9999 NE 2ND AVE STE 203
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-2345
Country	:	US
Telephone Number	:	786-580-5131
Fax Number	:	786-580-5149

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

Provider Enumeration Date	:	08/02/2017
Last Update Date	:	06/15/2020

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Directions to “ WILFREDO MORALES GONZALEZ ” Practice Location

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