MEDICARE: MADAIVY GONZALEZ ACOSTA

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		FL

General Provider Information

NPI Number	:	1912731738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADAIVY GONZALEZ ACOSTA

Provider Business Mailing Address
First Line	:	20310 SW 106TH CT
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-1330
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20310 SW 106TH CT
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-1330
Country	:	US
Telephone Number	:	786-578-8233
Fax Number	:

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

Provider Enumeration Date	:	08/26/2024
Last Update Date	:	08/26/2024

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