Provider Demographics
NPI:1578171427
Name:GONZALEZ MARTINEZ, LARRY (RBT)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:GONZALEZ MARTINEZ
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 1:9600 SW 8TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2947
Mailing Address - Country:US
Mailing Address - Phone:786-838-9455
Mailing Address - Fax:
Practice Address - Street 1:9600 SW 8TH ST STE 2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2947
Practice Address - Country:US
Practice Address - Phone:786-838-9455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20-117230106S00000X
FLH-4A51D6374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician