Provider Demographics
NPI:1568181246
Name:GONZALEZ, JOSE JAVIER (RBT)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:JAVIER
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6171 SW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-5102
Mailing Address - Country:US
Mailing Address - Phone:561-584-0502
Mailing Address - Fax:
Practice Address - Street 1:6171 SW 41ST ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-5102
Practice Address - Country:US
Practice Address - Phone:561-584-0502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22-227053106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115057700Medicaid