Healthcare Provider Details

I. General information

NPI: 1679138390
Provider Name (Legal Business Name): KARIN GONZALEZ LEON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12700 SW 122ND AVE STE 110
MIAMI FL
33186-5271
US

IV. Provider business mailing address

615 NE 22ND ST
MIAMI FL
33137-5107
US

V. Phone/Fax

Practice location:
  • Phone: 786-353-2900
  • Fax: 786-364-1676
Mailing address:
  • Phone: 954-997-3629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-84458
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: