Healthcare Provider Details

I. General information

NPI: 1285556399
Provider Name (Legal Business Name): NATHALIE GOMEZ LORENZO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 W 44TH ST
HIALEAH FL
33012-3922
US

IV. Provider business mailing address

329 W 44TH ST
HIALEAH FL
33012-3922
US

V. Phone/Fax

Practice location:
  • Phone: 786-585-2021
  • Fax:
Mailing address:
  • Phone: 786-585-2021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2830678
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: