Healthcare Provider Details

I. General information

NPI: 1992502579
Provider Name (Legal Business Name): ARACELYS GONZALEZ ROSALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 SE PORT ST LUCIE BLVD
PORT ST LUCIE FL
34984-5108
US

IV. Provider business mailing address

4161 HAPPINESS ST
WEST PALM BEACH FL
33406-4847
US

V. Phone/Fax

Practice location:
  • Phone: 772-202-0173
  • Fax: 772-209-7631
Mailing address:
  • Phone: 561-805-4669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-414415
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: