MEDICARE: MARCO A 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	103K00000X	Behavior Analyst	BCBA-1-26-87483	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	:	1427675081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCO A GONZALEZ

Provider Business Mailing Address
First Line	:	824 S LAKE DR
Second Line	:
City	:	LANTANA
State	:	FL
Zip	:	33462-4626
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	824 S LAKE DR
Second Line	:
City	:	LANTANA
State	:	FL
Zip	:	33462-4626
Country	:	US
Telephone Number	:	561-523-2011
Fax Number	:

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

Provider Enumeration Date	:	06/30/2020
Last Update Date	:	02/05/2026

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Directions to “ MARCO A GONZALEZ ” Practice Location

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