Most Relevant Information
Provider Data
| NPI Number: | 1003332073 |
| Provider Name: | JUAN C GONZALEZ IBARRA |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/21/2017 |
| Last Updated: | 07/21/2022 |
Provider Practice Location
800 NE 12TH AVE APT# C214
HOMESTEAD
FL
33030
Practice Location Phone/Fax
| Phone: | 7866910896 |
| Fax: |
Provider Mailing Location
800 NE 12TH AVE APT C214
HOMESTEAD
FL
330305005
Provider Mailing Phone/Fax
| Phone: | 7866910896 |
| Fax: |