Healthcare Provider Details

I. General information

NPI: 1982537841
Provider Name (Legal Business Name): ELIZABETH CARMENATE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11076 W 33RD WAY
HIALEAH FL
33018-2196
US

IV. Provider business mailing address

11076 W 33RD WAY
HIALEAH FL
33018-2196
US

V. Phone/Fax

Practice location:
  • Phone: 786-874-1377
  • Fax:
Mailing address:
  • Phone: 786-874-1377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: