Healthcare Provider Details

I. General information

NPI: 1396600391
Provider Name (Legal Business Name): MAIBY GOMEZ GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3429 W 80TH ST APT 203
HIALEAH FL
33018-7571
US

IV. Provider business mailing address

3429 W 80TH ST APT 203
HIALEAH FL
33018-7571
US

V. Phone/Fax

Practice location:
  • Phone: 786-316-2184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number25-502189
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: