Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-21-54657 | FL |
N | 106E00000X | Assistant Behavior Analyst | ||
N | 106S00000X | Behavior Technician |
NPI | 1093162901 |
---|---|
Provider Name | Mr. Carlos A Gonzalez Orta |
First Address | Hialeah, FL 33013-2847 |
Second Address | Hialeah, FL 33013-2847 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2016 |
Last Update Date | 03/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017512900 | (05) | FL |