MEDICARE: AIDA H GONZALEZ GUTIERREZ

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
2	106S00000X	Behavior Technician	RBT-20-16767	FL

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	:	1679008700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIDA H GONZALEZ GUTIERREZ

Provider Business Mailing Address
First Line	:	10420 NW 129TH ST
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-6004
Country	:	US
Telephone Number	:	305-747-8984
Fax Number	:

Provider Business Practice Location Address
First Line	:	10420 NW 129TH ST
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-6004
Country	:	US
Telephone Number	:	305-747-8984
Fax Number	:

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

Provider Enumeration Date	:	04/26/2017
Last Update Date	:	05/10/2022

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