Healthcare Provider Details

I. General information

NPI: 1558282988
Provider Name (Legal Business Name): MILEYBIS GONZALEZ GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2039NW 152ND TERRACE
MIAMI GARDENS FL
33054
US

IV. Provider business mailing address

2039NW 152ND TERRACE
MIAMI GARDENS FL
33054
US

V. Phone/Fax

Practice location:
  • Phone: 786-898-5981
  • Fax:
Mailing address:
  • Phone: 786-898-5981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1285960
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: