Healthcare Provider Details

I. General information

NPI: 1629859020
Provider Name (Legal Business Name): CRYSTIAN GALVEZ BCABA 0-26-17073
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 NW 24TH PL
CAPE CORAL FL
33993-4322
US

IV. Provider business mailing address

314 NW 24TH PL
CAPE CORAL FL
33993-4322
US

V. Phone/Fax

Practice location:
  • Phone: 786-608-6325
  • Fax:
Mailing address:
  • Phone: 786-608-6325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberBCABA02617073
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: