MEDICARE: GIZELLE GALLIGUEZ

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	225XP0200X	Pediatric Occupational Therapist	20802	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982221792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GIZELLE GALLIGUEZ

Provider Business Mailing Address
First Line	:	3609 DATA DR APT 203
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-6156
Country	:	US
Telephone Number	:	786-516-8710
Fax Number	:

Provider Business Practice Location Address
First Line	:	3609 DATA DR APT 203
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-6156
Country	:	US
Telephone Number	:	786-516-8710
Fax Number	:

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

Provider Enumeration Date	:	06/26/2020
Last Update Date	:	06/26/2020

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Directions to “ GIZELLE GALLIGUEZ ” Practice Location

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