Healthcare Provider Details

I. General information

NPI: 1568009850
Provider Name (Legal Business Name): LINET GONZALEZ RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1887 SE PORT ST LUCIE BLVD
PORT ST LUCIE FL
34952-5530
US

IV. Provider business mailing address

3958 JUPITER BLVD SE
PALM BAY FL
32909-3861
US

V. Phone/Fax

Practice location:
  • Phone: 772-463-0444
  • Fax: 727-219-1339
Mailing address:
  • Phone: 786-719-6787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-93287
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: