Provider Demographics
NPI:1740721893
Name:GONZALEZ HEALTH SERVICES CORP.
Entity type:Organization
Organization Name:GONZALEZ HEALTH SERVICES CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ISIDRO
Authorized Official - Middle Name:F
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:786-286-8637
Mailing Address - Street 1:10700 CARIBBEAN BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189
Mailing Address - Country:US
Mailing Address - Phone:786-738-6475
Mailing Address - Fax:786-842-3648
Practice Address - Street 1:10700 CARIBBEAN BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189
Practice Address - Country:US
Practice Address - Phone:786-738-6475
Practice Address - Fax:786-842-3648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017808900Medicaid
FL100081300Medicaid
FL100746800Medicaid