Healthcare Provider Details

I. General information

NPI: 1043075377
Provider Name (Legal Business Name): MR. NELSON GONZALEZ ALMEIDA SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 FORREST DR APT 207
MIAMI SPRINGS FL
33166-7268
US

IV. Provider business mailing address

615 FORREST DR APT 207
MIAMI SPRINGS FL
33166-7268
US

V. Phone/Fax

Practice location:
  • Phone: 786-229-0068
  • Fax:
Mailing address:
  • Phone: 786-229-0068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberG524-620-00-295-1
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: