Provider Demographics
NPI:1528698701
Name:GONZALEZ BATISTA, MELISSA D
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:D
Last Name:GONZALEZ BATISTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 SW 75TH AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1590
Mailing Address - Country:US
Mailing Address - Phone:786-448-8727
Mailing Address - Fax:
Practice Address - Street 1:6514 SW 128TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-1374
Practice Address - Country:US
Practice Address - Phone:786-448-8727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-106736106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician