Healthcare Provider Details

I. General information

NPI: 1508482274
Provider Name (Legal Business Name): MARIA ISABEL GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S DOUGLAS RD STE 230
CORAL GABLES FL
33134-4108
US

IV. Provider business mailing address

878 W 34TH ST
HIALEAH FL
33012-5160
US

V. Phone/Fax

Practice location:
  • Phone: 305-846-9807
  • Fax: 305-846-9711
Mailing address:
  • Phone: 786-768-6784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-64806
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: