Healthcare Provider Details

I. General information

NPI: 1497103113
Provider Name (Legal Business Name): KETTY GONZALEZ RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581 SE 5TH ST
HIALEAH FL
33010-5328
US

IV. Provider business mailing address

581 SE 5TH ST
HIALEAH FL
33010-5328
US

V. Phone/Fax

Practice location:
  • Phone: 786-901-9210
  • Fax:
Mailing address:
  • Phone: 786-901-9210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number15-01728
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: