MEDICARE: DESTINY GAXIOLA

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	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1851187868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESTINY GAXIOLA

Provider Business Mailing Address
First Line	:	1043 W HAMILTON AVE
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-3815
Country	:	US
Telephone Number	:	442-258-2370
Fax Number	:

Provider Business Practice Location Address
First Line	:	1043 W HAMILTON AVE
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-3815
Country	:	US
Telephone Number	:	442-258-2370
Fax Number	:

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

Provider Enumeration Date	:	04/16/2025
Last Update Date	:	04/16/2025

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Directions to “ DESTINY GAXIOLA ” Practice Location

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