Healthcare Provider Details

I. General information

NPI: 1972957066
Provider Name (Legal Business Name): LYNETTE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7411 S WATERWAY DR
MIAMI FL
33155-2707
US

IV. Provider business mailing address

7411 S WATERWAY DR
MIAMI FL
33155-2707
US

V. Phone/Fax

Practice location:
  • Phone: 305-582-4530
  • Fax:
Mailing address:
  • Phone: 305-582-4530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88584
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT17627
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: