Healthcare Provider Details

I. General information

NPI: 1740721893
Provider Name (Legal Business Name): GONZALEZ HEALTH SERVICES CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2017
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 CARIBBEAN BLVD SUITE 305
CUTLER BAY FL
33189
US

IV. Provider business mailing address

10700 CARIBBEAN BLVD SUITE 305
CUTLER BAY FL
33189
US

V. Phone/Fax

Practice location:
  • Phone: 786-738-6475
  • Fax: 786-842-3648
Mailing address:
  • Phone: 786-738-6475
  • Fax: 786-842-3648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ISIDRO F GONZALEZ
Title or Position: CEO
Credential: BCBA
Phone: 786-286-8637