Healthcare Provider Details

I. General information

NPI: 1497524789
Provider Name (Legal Business Name): MAIRELIS GIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 S CONGRESS AVE STE 103
PALM SPRINGS FL
33461-2502
US

IV. Provider business mailing address

5211 GINGER WAY # 282
LAKE WORTH FL
33463-4440
US

V. Phone/Fax

Practice location:
  • Phone: 702-945-7684
  • Fax:
Mailing address:
  • Phone: 702-945-7684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-156572
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: