Healthcare Provider Details

I. General information

NPI: 1184470890
Provider Name (Legal Business Name): MARIA DE LOURDES ESTRADA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14158 SW 145TH PL
MIAMI FL
33186-6786
US

IV. Provider business mailing address

14158 SW 145TH PL
MIAMI FL
33186-6786
US

V. Phone/Fax

Practice location:
  • Phone: 305-508-8564
  • Fax:
Mailing address:
  • Phone: 305-508-8564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA-1-26-2845181
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-338980
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: