Healthcare Provider Details

I. General information

NPI: 1588449904
Provider Name (Legal Business Name): ANA LAURA GONZALEZ QUINTANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3212 STRAWFLOWER WAY APT 207
LAKE WORTH FL
33467-1944
US

IV. Provider business mailing address

3212 STRAWFLOWER WAY
LAKE WORTH FL
33467-1991
US

V. Phone/Fax

Practice location:
  • Phone: 561-785-9247
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA-1-26-89595
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: