Healthcare Provider Details

I. General information

NPI: 1770415200
Provider Name (Legal Business Name): PHILIP GABRIEL MAINGOT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4964 N PALM AVE
WINTER PARK FL
32792-9111
US

IV. Provider business mailing address

8062 DUNSTABLE CIR
ORLANDO FL
32817-1253
US

V. Phone/Fax

Practice location:
  • Phone: 321-228-3765
  • Fax:
Mailing address:
  • Phone: 407-300-4360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-540774
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: