Healthcare Provider Details

I. General information

NPI: 1871415265
Provider Name (Legal Business Name): JOEL ELIZONDO GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1568 SW 2ND ST
HOMESTEAD FL
33030-6692
US

IV. Provider business mailing address

1568 SW 2ND ST
HOMESTEAD FL
33030-6692
US

V. Phone/Fax

Practice location:
  • Phone: 786-609-0814
  • Fax:
Mailing address:
  • Phone: 786-609-0814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT26-543795
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: