MEDICARE: LISET GOMEZ MORALES

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	23-266050	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	:	1841995149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISET GOMEZ MORALES

Provider Business Mailing Address
First Line	:	1048 AUGUST SKY DR
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32738-9124
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7448 ALOMA AVE STE 1
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-9171
Country	:	US
Telephone Number	:	321-295-0315
Fax Number	:

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

Provider Enumeration Date	:	04/04/2023
Last Update Date	:	01/20/2026

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Directions to “ LISET GOMEZ MORALES ” Practice Location

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