MEDICARE: RAQUEL 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	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1639612732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAQUEL GONZALEZ

Provider Business Mailing Address
First Line	:	16085 NW 41ST AVE
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33054-6105
Country	:	US
Telephone Number	:	786-210-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	16085 NW 41ST AVE
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33054-6105
Country	:	US
Telephone Number	:	786-210-4400
Fax Number	:

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

Provider Enumeration Date	:	11/22/2016
Last Update Date	:	04/22/2025

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Directions to “ RAQUEL GONZALEZ ” Practice Location

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