Healthcare Provider Details

I. General information

NPI: 1124707096
Provider Name (Legal Business Name): ROMILKA GONZALEZ GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 COLLEGE PKWY STE 107
FORT MYERS FL
33919-4111
US

IV. Provider business mailing address

154 SE 18TH TER
CAPE CORAL FL
33990-2269
US

V. Phone/Fax

Practice location:
  • Phone: 239-360-7967
  • Fax:
Mailing address:
  • Phone: 239-600-8911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-284409
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: