MEDICARE: MIA BELLA GONZALEZ-OLIVA

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	:	1811843428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA BELLA GONZALEZ-OLIVA

Provider Business Mailing Address
First Line	:	200 SW 124TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33184-1416
Country	:	US
Telephone Number	:	305-753-4140
Fax Number	:	305-753-4140

Provider Business Practice Location Address
First Line	:	8040 NW 95TH ST
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2362
Country	:	US
Telephone Number	:	954-397-8635
Fax Number	:

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

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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