Provider Demographics
NPI:1659141026
Name:GONZALEZ, MARLON RUBEN (RBT)
Entity Type:Individual
Prefix:
First Name:MARLON
Middle Name:RUBEN
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 1:10131 HAITIAN DR
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1642
Mailing Address - Country:US
Mailing Address - Phone:305-484-4919
Mailing Address - Fax:
Practice Address - Street 1:10131 HAITIAN DR
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1642
Practice Address - Country:US
Practice Address - Phone:305-484-4919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-319255106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician