Individual
OSVALDO GONZALEZ LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BCABA
Contact information
Practice address
15819 NW 4TH ST, PEMBROKE PINES, FL 33028-1593
(305) 987-1377
Mailing address
8974 NW 112TH TER, HIALEAH, FL 33018-4517
(305) 987-1377
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
19-9923
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023554800
—
FL
Enumeration date
12/26/2018
Last updated
12/20/2019
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