Healthcare Provider Details

I. General information

NPI: 1164162897
Provider Name (Legal Business Name): DILIA GOMEZ-QUEIRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 E GARDNER WAY STE F
WASILLA AK
99654-6564
US

IV. Provider business mailing address

5965 BENT PINE DR APT 2127
ORLANDO FL
32822-6603
US

V. Phone/Fax

Practice location:
  • Phone: 907-214-1580
  • Fax: 907-308-6744
Mailing address:
  • Phone: 510-303-2417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-215727
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: