Provider Demographics
NPI:1154148120
Name:LOBO GONZALEZ, EDUARDO ALEJANDRO
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:ALEJANDRO
Last Name:LOBO GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27240 SW 136TH PATH
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-2519
Mailing Address - Country:US
Mailing Address - Phone:786-391-6052
Mailing Address - Fax:
Practice Address - Street 1:27240 SW 136TH PATH
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-2519
Practice Address - Country:US
Practice Address - Phone:786-391-6052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-379247106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician