Healthcare Provider Details

I. General information

NPI: 1710143953
Provider Name (Legal Business Name): KIMBERLY R GONZALEZ ED.S., BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9402 BULLFROG CT
GIBSONTON FL
33534-5100
US

IV. Provider business mailing address

PO BOX 1275
RIVERVIEW FL
33568-1275
US

V. Phone/Fax

Practice location:
  • Phone: 727-424-6209
  • Fax: 813-671-4645
Mailing address:
  • Phone: 813-335-8296
  • Fax: 813-671-4645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: