Healthcare Provider Details

I. General information

NPI: 1508760885
Provider Name (Legal Business Name): ENGIE LITAY GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 N 12TH ST APT 1215
PHOENIX AZ
85014-4622
US

IV. Provider business mailing address

4225 N 12TH ST APT 1215
PHOENIX AZ
85014-4622
US

V. Phone/Fax

Practice location:
  • Phone: 160-264-9014
  • Fax:
Mailing address:
  • Phone: 160-264-9014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number2702705
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: