Healthcare Provider Details

I. General information

NPI: 1891614327
Provider Name (Legal Business Name): EMELY WOODS GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 SANTA BARBARA BLVD
CAPE CORAL FL
33991-8039
US

IV. Provider business mailing address

1455 SE 15TH ST
CAPE CORAL FL
33990-3773
US

V. Phone/Fax

Practice location:
  • Phone: 239-422-6031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-549159
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: