Healthcare Provider Details

I. General information

NPI: 1538099965
Provider Name (Legal Business Name): GILBERTO RAVELO GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 SW 42ND AVE
CORAL GABLES FL
33134-1752
US

IV. Provider business mailing address

220 SW 42ND AVE
CORAL GABLES FL
33134-1752
US

V. Phone/Fax

Practice location:
  • Phone: 786-597-9108
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-538651
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: