Healthcare Provider Details

I. General information

NPI: 1093514010
Provider Name (Legal Business Name): NAYARA NAIVI MIRABALES GONZALEZ BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 BUDINGER AVE
SAINT CLOUD FL
34769-7203
US

IV. Provider business mailing address

6463 SEXTANT CT
ORLANDO FL
32807-4647
US

V. Phone/Fax

Practice location:
  • Phone: 407-498-4079
  • Fax:
Mailing address:
  • Phone: 689-276-5317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-314494
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA1-26-88924
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: