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General NPI Number Information
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NPI Number | 1346122322
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Entity Type | Individual
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Provider Name | ODALIS DE LA CRUZ GONZALEZ
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Gender | Female
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 1400 NW 107TH AVE STE 306
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City | SWEETWATER
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State | FL
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Zip | 33172-2746
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Country | US
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Telephone | 305-502-6282
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Fax |
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Provider Business Mailing Address
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Address Line | 12209 SW 14TH LN APT 1109
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City | MIAMI
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State | FL
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Zip | 33184-2806
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Country | US
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Telephone | 786-346-6066
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-24-329540
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License Number State | FL
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