Provider Demographics
NPI:1487354593
Name:MARTIN GONZALEZ, ARNALDO
Entity type:Individual
Prefix:
First Name:ARNALDO
Middle Name:
Last Name:MARTIN 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 1:1356 S BETTY LN
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3502
Mailing Address - Country:US
Mailing Address - Phone:786-712-1792
Mailing Address - Fax:
Practice Address - Street 1:1356 S BETTY LN
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3502
Practice Address - Country:US
Practice Address - Phone:786-712-1792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-8615-512366106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician