MEDICARE: AIDA M PUCHADES 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	251B00000X	Case Management Agency	0102856	FL
2	2355S0801X	Speech-Language Assistant	SI8398	FL

General Provider Information

NPI Number	:	1255290391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIDA M PUCHADES GONZALEZ

Provider Business Mailing Address
First Line	:	1155 W 27TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-1116
Country	:	US
Telephone Number	:	305-781-1104
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 W 27TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-1116
Country	:	US
Telephone Number	:	305-781-1104
Fax Number	:

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

Provider Enumeration Date	:	01/15/2026
Last Update Date	:	06/02/2026

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