Healthcare Provider Details

I. General information

NPI: 1003677147
Provider Name (Legal Business Name): MARICARMEN GONZALEZ PASCUAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22385 SW 107TH AVE APT E214
MIAMI FL
33170-6621
US

IV. Provider business mailing address

22385 SW 107TH AVE APT E214
MIAMI FL
33170-6621
US

V. Phone/Fax

Practice location:
  • Phone: 786-648-9182
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89428
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-321129
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: