Healthcare Provider Details

I. General information

NPI: 1023674678
Provider Name (Legal Business Name): ELIBET GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2019
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E 55TH ST
HIALEAH FL
33013-1437
US

IV. Provider business mailing address

50 E 55TH ST
HIALEAH FL
33013-1437
US

V. Phone/Fax

Practice location:
  • Phone: 786-306-5525
  • Fax:
Mailing address:
  • Phone: 786-306-5525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-24-15663
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: