MEDICARE: KARIN GONZALEZ LEON

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	RBT-19-84458	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	:	1679138390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARIN GONZALEZ LEON

Provider Business Mailing Address
First Line	:	615 NE 22ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33137-5107
Country	:	US
Telephone Number	:	954-997-3629
Fax Number	:

Provider Business Practice Location Address
First Line	:	12700 SW 122ND AVE STE 110
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-5271
Country	:	US
Telephone Number	:	786-353-2900
Fax Number	:	786-364-1676

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

Provider Enumeration Date	:	05/08/2019
Last Update Date	:	05/08/2019

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Directions to “ KARIN GONZALEZ LEON ” Practice Location

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