MEDICARE: GABRIELA MARY PEREZ CRUZ

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-24-353699	FL

General Provider Information

NPI Number	:	1790517688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELA MARY PEREZ CRUZ

Provider Business Mailing Address
First Line	:	6215 W 22ND CT APT 19
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-3985
Country	:	US
Telephone Number	:	786-797-7670
Fax Number	:

Provider Business Practice Location Address
First Line	:	6215 W 22ND CT APT 19
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-3985
Country	:	US
Telephone Number	:	786-797-7670
Fax Number	:

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

Provider Enumeration Date	:	08/19/2024
Last Update Date	:	08/29/2024

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