MEDICARE: GILDA D MORENO LOPEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-25-430144	FL

General Provider Information

NPI Number	:	1518756212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GILDA D MORENO LOPEZ

Provider Business Mailing Address
First Line	:	820 NW EMBERS TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33993-7756
Country	:	US
Telephone Number	:	239-222-0767
Fax Number	:

Provider Business Practice Location Address
First Line	:	1432 GRAHAM CIR
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33936-1110
Country	:	US
Telephone Number	:	305-390-2369
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2025
Last Update Date	:	05/31/2026

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