MEDICARE: ROSA 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	1868092	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144978479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSA GONZALEZ

Provider Business Mailing Address
First Line	:	830 NE 1ST PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-5103
Country	:	US
Telephone Number	:	786-691-6772
Fax Number	:

Provider Business Practice Location Address
First Line	:	830 NE 1ST PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-5103
Country	:	US
Telephone Number	:	786-691-6772
Fax Number	:

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

Provider Enumeration Date	:	03/15/2022
Last Update Date	:	03/16/2022

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Directions to “ ROSA GONZALEZ ” Practice Location

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