MEDICARE: MIREL 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	RBT-24-386532	FL

General Provider Information

NPI Number	:	1780406835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIREL GONZALEZ RODRIGUEZ

Provider Business Mailing Address
First Line	:	13581 EAGLE RIDGE DR APT 1421
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-6814
Country	:	US
Telephone Number	:	239-710-0800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3677 CENTRAL AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8226
Country	:	US
Telephone Number	:	239-789-1721
Fax Number	:

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

Provider Enumeration Date	:	10/29/2024
Last Update Date	:	03/02/2026

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