MEDICARE: GABRIEL PITA I

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1912363169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL PITA I

Provider Business Mailing Address
First Line	:	11755 SW 90TH ST STE 210
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-2178
Country	:	US
Telephone Number	:	305-846-9807
Fax Number	:	305-846-9711

Provider Business Practice Location Address
First Line	:	10330 SW 118TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-4009
Country	:	US
Telephone Number	:	786-573-3070
Fax Number	:

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

Provider Enumeration Date	:	01/04/2016
Last Update Date	:	01/04/2016

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Directions to “ GABRIEL PITA I ” Practice Location

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