Healthcare Provider Details

I. General information

NPI: 1811764681
Provider Name (Legal Business Name): GABRIELA SUSANA VELASQUEZ BT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 BIRKDALE DR
WELLINGTON FL
33414-5809
US

IV. Provider business mailing address

11011 SHERIDAN ST STE 210
HOLLYWOOD FL
33026-1531
US

V. Phone/Fax

Practice location:
  • Phone: 954-552-6668
  • Fax:
Mailing address:
  • Phone: 954-552-6668
  • Fax: 954-206-5584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: