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General NPI Number Information
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NPI Number | 1770340127
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Entity Type | Individual
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Provider Name | EXXON A GONZALEZ
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Gender | Male
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Dates
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Enumeration Date | 03/04/2024
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Last Update Date | 03/12/2024
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Provider Practice Location Address
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Address Line | 11620 SW 185TH ST
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City | MIAMI
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State | FL
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Zip | 33157-6518
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Country | US
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Telephone | 786-972-6363
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Fax |
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Provider Business Mailing Address
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Address Line | 11620 SW 185TH ST
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City | MIAMI
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State | FL
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Zip | 33157-6518
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Country | US
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Telephone | 786-972-6363
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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-24-331044
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 246ZN0300X
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Taxonomy Name | Nephrology Specialist/Technologist
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License Number | 223487
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License Number State | FL
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