Healthcare Provider Details

I. General information

NPI: 1144728585
Provider Name (Legal Business Name): ALYSSA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 SW 72ND ST STE 114
MIAMI FL
33173-3038
US

IV. Provider business mailing address

11060 N KENDALL DR
MIAMI FL
33176-1272
US

V. Phone/Fax

Practice location:
  • Phone: 305-508-5580
  • Fax:
Mailing address:
  • Phone: 305-668-8644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-52852
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: