MEDICARE: OLGA CARIDAD LEON 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	106S00000X	Behavior Technician	RBT-24-386554	FL

General Provider Information

NPI Number	:	1811847056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLGA CARIDAD LEON GONZALEZ

Provider Business Mailing Address
First Line	:	4437 W HUMPHREY ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-1428
Country	:	US
Telephone Number	:	786-586-5684
Fax Number	:

Provider Business Practice Location Address
First Line	:	4437 W HUMPHREY ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-1428
Country	:	US
Telephone Number	:	786-586-5684
Fax Number	:

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

Provider Enumeration Date	:	01/28/2026
Last Update Date	:	01/28/2026

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