Provider Demographics
NPI:1588804702
Name:GONZALEZ, HECTOR PAULINO (BCBA)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:PAULINO
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16249 SW 48TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5157
Mailing Address - Country:US
Mailing Address - Phone:786-317-2004
Mailing Address - Fax:
Practice Address - Street 1:12150 SW 128TH CT
Practice Address - Street 2:STE 222
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4647
Practice Address - Country:US
Practice Address - Phone:786-701-8164
Practice Address - Fax:786-701-3975
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLATN 624248Medicaid