MEDICARE: ZUYLEN DE LA CARIDAD MIRANDA 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	24-386950	FL

General Provider Information

NPI Number	:	1982405510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZUYLEN DE LA CARIDAD MIRANDA GONZALEZ

Provider Business Mailing Address
First Line	:	125 ZAMORA AVE
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4045
Country	:	US
Telephone Number	:	786-792-8248
Fax Number	:

Provider Business Practice Location Address
First Line	:	1137 BARTOW RD STE 207
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-5828
Country	:	US
Telephone Number	:	786-278-8655
Fax Number	:	863-583-8955

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

Provider Enumeration Date	:	03/20/2025
Last Update Date	:	03/20/2025

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