Provider Demographics
NPI:1619768009
Name:GONZALEZ ALCANTARA, ANTONIO JOSE
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:JOSE
Last Name:GONZALEZ ALCANTARA
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 1:1455 N TREASURE DR APT 2N
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4101
Mailing Address - Country:US
Mailing Address - Phone:636-362-3214
Mailing Address - Fax:
Practice Address - Street 1:1455 N TREASURE DR APT 2N
Practice Address - Street 2:
Practice Address - City:NORTH BAY VILLAGE
Practice Address - State:FL
Practice Address - Zip Code:33141-4101
Practice Address - Country:US
Practice Address - Phone:636-362-3214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-433319106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician