Healthcare Provider Details

I. General information

NPI: 1568326643
Provider Name (Legal Business Name): HELEN GONZALEZ MORENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 SE 17TH AVE
CAPE CORAL FL
33990-3801
US

IV. Provider business mailing address

7050 EASTWOOD ACRES RD
FORT MYERS FL
33905-6114
US

V. Phone/Fax

Practice location:
  • Phone: 239-205-6766
  • Fax:
Mailing address:
  • Phone: 954-483-1012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number25-468780
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: