Healthcare Provider Details

I. General information

NPI: 1235072463
Provider Name (Legal Business Name): ANA LAURA GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3242 W 70TH ST UNIT 101
HIALEAH GARDENS FL
33018-7148
US

IV. Provider business mailing address

3242 W 70TH ST UNIT 101
HIALEAH GARDENS FL
33018-7148
US

V. Phone/Fax

Practice location:
  • Phone: 786-473-6401
  • Fax:
Mailing address:
  • Phone: 786-473-6401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberG245-732-57-600-0
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: