Healthcare Provider Details

I. General information

NPI: 1124894274
Provider Name (Legal Business Name): ARISMAY RODRIGUEZ GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 JORK RD # 401-402
JACKSONVILLE FL
32207-2491
US

IV. Provider business mailing address

1765 LAKEMONT CIR
MIDDLEBURG FL
32068-6623
US

V. Phone/Fax

Practice location:
  • Phone: 904-662-7093
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-306647
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: