MEDICARE: ARISMAY RODRIGUEZ 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	RBT-23-306647	FL

General Provider Information

NPI Number	:	1124894274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARISMAY RODRIGUEZ GONZALEZ

Provider Business Mailing Address
First Line	:	1765 LAKEMONT CIR
Second Line	:
City	:	MIDDLEBURG
State	:	FL
Zip	:	32068-6623
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1616 JORK RD # 401-402
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-2491
Country	:	US
Telephone Number	:	904-662-7093
Fax Number	:

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

Provider Enumeration Date	:	11/29/2023
Last Update Date	:	04/22/2026

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