Healthcare Provider Details

I. General information

NPI: 1124804265
Provider Name (Legal Business Name): MELANIE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17730 NW 82ND AVE
HIALEAH FL
33015-3631
US

IV. Provider business mailing address

17730 NW 82ND AVE
HIALEAH FL
33015-3631
US

V. Phone/Fax

Practice location:
  • Phone: 786-897-6329
  • Fax:
Mailing address:
  • Phone: 786-897-6329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-2845808
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number23-293462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: