MEDICARE: NATALIE GONZALEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1053262907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE GONZALEZ

Provider Business Mailing Address
First Line	:	745 ORIENTA AVE STE 1011
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-5675
Country	:	US
Telephone Number	:	877-823-4283
Fax Number	:

Provider Business Practice Location Address
First Line	:	823 DUNLAWTON AVE
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4220
Country	:	US
Telephone Number	:	877-823-4283
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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