Healthcare Provider Details

I. General information

NPI: 1104772995
Provider Name (Legal Business Name): MELISSA MARIA GONZALEZ QUIJANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15884 SW 137TH AVE
MIAMI FL
33177-1204
US

IV. Provider business mailing address

101 NW 48TH PL
MIAMI FL
33126-5123
US

V. Phone/Fax

Practice location:
  • Phone: 305-456-6002
  • Fax:
Mailing address:
  • Phone: 786-585-6420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: