Healthcare Provider Details

I. General information

NPI: 1538099981
Provider Name (Legal Business Name): LILIET VIGO GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8850 NW 36TH ST APT 2123
DORAL FL
33178-4040
US

IV. Provider business mailing address

8850 NW 36TH ST APT 2123
DORAL FL
33178-4040
US

V. Phone/Fax

Practice location:
  • Phone: 786-617-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89892
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: