Healthcare Provider Details

I. General information

NPI: 1578171427
Provider Name (Legal Business Name): LARRY GONZALEZ MARTINEZ RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 SW 8TH ST STE 2
MIAMI FL
33174-2947
US

IV. Provider business mailing address

9600 SW 8TH ST STE 2
MIAMI FL
33174-2947
US

V. Phone/Fax

Practice location:
  • Phone: 786-838-9455
  • Fax:
Mailing address:
  • Phone: 786-838-9455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberH-4A51D6
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number20-117230
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: