Provider Demographics
NPI:1609767912
Name:VENTO GONZALEZ, GASPAR ALEJANDRO
Entity type:Individual
Prefix:
First Name:GASPAR
Middle Name:ALEJANDRO
Last Name:VENTO 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 1:874 NW 135TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-3168
Mailing Address - Country:US
Mailing Address - Phone:754-215-9483
Mailing Address - Fax:
Practice Address - Street 1:7971 RIVIERA BLVD STE 402
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-6449
Practice Address - Country:US
Practice Address - Phone:954-642-1186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-446050106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician