Healthcare Provider Details

I. General information

NPI: 1518756212
Provider Name (Legal Business Name): GILDA D MORENO LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 GRAHAM CIR
LEHIGH ACRES FL
33936-1110
US

IV. Provider business mailing address

820 NW EMBERS TER
CAPE CORAL FL
33993-7756
US

V. Phone/Fax

Practice location:
  • Phone: 305-390-2369
  • Fax:
Mailing address:
  • Phone: 239-222-0767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-430144
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: