Healthcare Provider Details

I. General information

NPI: 1558054635
Provider Name (Legal Business Name): KAREN K GONZALEZ GAVIRIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3077 WHISPER LAKE LN APT B
WINTER PARK FL
32792-8023
US

IV. Provider business mailing address

3077 WHISPER LAKE LN APT B
WINTER PARK FL
32792-8023
US

V. Phone/Fax

Practice location:
  • Phone: 407-557-7825
  • Fax:
Mailing address:
  • Phone: 407-557-7825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-272499
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: