MEDICARE: PABLO FELIX GONZALEZ RODRIGUEZ

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
2	106S00000X	Behavior Technician	20-143902	FL

General Provider Information

NPI Number	:	1366025983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PABLO FELIX GONZALEZ RODRIGUEZ

Provider Business Mailing Address
First Line	:	6849 NW 173RD DR APT 202F
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-5569
Country	:	US
Telephone Number	:	786-326-3068
Fax Number	:

Provider Business Practice Location Address
First Line	:	6849 NW 173RD DR APT 202F
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-5569
Country	:	US
Telephone Number	:	786-326-3068
Fax Number	:

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

Provider Enumeration Date	:	05/02/2021
Last Update Date	:	05/17/2021

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Directions to “ PABLO FELIX GONZALEZ RODRIGUEZ ” Practice Location

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