Healthcare Provider Details

I. General information

NPI: 1518898048
Provider Name (Legal Business Name): YUDISEL GUTIERREZ RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3107 42ND ST SW
LEHIGH ACRES FL
33976-4754
US

IV. Provider business mailing address

3107 42ND ST SW
LEHIGH ACRES FL
33976-4754
US

V. Phone/Fax

Practice location:
  • Phone: 239-200-5100
  • Fax:
Mailing address:
  • Phone: 239-200-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1292587
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: