MEDICARE: SUSET THALIA GONZALEZ DUQUE

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-20-135856	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	:	1437741857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSET THALIA GONZALEZ DUQUE

Provider Business Mailing Address
First Line	:	2638 TAYLOR ST APT E5
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-7505
Country	:	US
Telephone Number	:	786-597-8543
Fax Number	:

Provider Business Practice Location Address
First Line	:	2638 TAYLOR ST APT E5
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-7505
Country	:	US
Telephone Number	:	786-597-8543
Fax Number	:

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

Provider Enumeration Date	:	02/08/2021
Last Update Date	:	11/04/2025

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