Healthcare Provider Details

I. General information

NPI: 1578120325
Provider Name (Legal Business Name): HEIDY D GONZALEZ PAZOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 SW 34TH TER
CAPE CORAL FL
33914-5034
US

IV. Provider business mailing address

214 SW 34TH TER
CAPE CORAL FL
33914-5034
US

V. Phone/Fax

Practice location:
  • Phone: 239-362-4042
  • Fax:
Mailing address:
  • Phone: 239-362-4042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90616
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: