Healthcare Provider Details

I. General information

NPI: 1285573204
Provider Name (Legal Business Name): EDITH ANDREA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8575 NW 5TH TER APT 4
MIAMI FL
33126-3886
US

IV. Provider business mailing address

8575 NW 5TH TER APT 4
MIAMI FL
33126-3886
US

V. Phone/Fax

Practice location:
  • Phone: 786-614-5271
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: