MEDICARE: AYMEE GONZALEZ SOSA

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

General Provider Information

NPI Number	:	1487180857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYMEE GONZALEZ SOSA

Provider Business Mailing Address
First Line	:	7922 GRAND CANAL DR.
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144
Country	:	US
Telephone Number	:	786-747-2120
Fax Number	:	305-742-2190

Provider Business Practice Location Address
First Line	:	7922 GRAND CANAL DR
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-2251
Country	:	US
Telephone Number	:	786-747-2120
Fax Number	:	305-742-2190

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

Provider Enumeration Date	:	05/04/2017
Last Update Date	:	05/04/2017

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