Healthcare Provider Details

I. General information

NPI: 1740150879
Provider Name (Legal Business Name): GEISYS GONZALEZ SANTANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11169 N KENDALL DR APT E108
MIAMI FL
33176-0915
US

IV. Provider business mailing address

11169 N KENDALL DR APT E108
MIAMI FL
33176-0915
US

V. Phone/Fax

Practice location:
  • Phone: 305-761-2758
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-487106
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: