MEDICARE: MISS CIELO ALEXANDRIA 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	G626567819000	FL

General Provider Information

NPI Number	:	1275414435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CIELO ALEXANDRIA GONZALEZ

Provider Business Mailing Address
First Line	:	1211 ISLAND SHORES DR
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33413-2118
Country	:	US
Telephone Number	:	561-698-3793
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 ISLAND SHORES DR
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33413-2118
Country	:	US
Telephone Number	:	561-698-3793
Fax Number	:

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

Provider Enumeration Date	:	09/11/2025
Last Update Date	:	03/13/2026

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