Healthcare Provider Details

I. General information

NPI: 1902760770
Provider Name (Legal Business Name): AILIN GONZALEZ SANTAMARINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6281 NW 171ST ST
HIALEAH FL
33015-4622
US

IV. Provider business mailing address

6281 NW 171ST ST
HIALEAH FL
33015-4622
US

V. Phone/Fax

Practice location:
  • Phone: 786-890-3990
  • Fax:
Mailing address:
  • Phone: 786-890-3990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-498140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: