MEDICARE: MONICA GONZALEZ RICARDO

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	:	1053833582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA GONZALEZ RICARDO

Provider Business Mailing Address
First Line	:	13120 SW 85TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-4330
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13120 SW 85TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-4330
Country	:	US
Telephone Number	:	786-545-6261
Fax Number	:

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

Provider Enumeration Date	:	07/17/2017
Last Update Date	:	07/17/2017

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