MEDICARE: KIRENIA GONZALEZ M.A., BCBA

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	103K00000X	Behavior Analyst

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	:	1538635529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRENIA GONZALEZ M.A., BCBA

Provider Business Mailing Address
First Line	:	6516 SW 112TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-1939
Country	:	US
Telephone Number	:	305-877-2013
Fax Number	:

Provider Business Practice Location Address
First Line	:	3990 SHERIDAN ST STE 209
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3656
Country	:	US
Telephone Number	:	888-754-0398
Fax Number	:

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

Provider Enumeration Date	:	10/17/2018
Last Update Date	:	10/17/2018

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