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General NPI Number Information
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NPI Number | 1912672429
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Entity Type | Individual
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Provider Name | GISELLE B RUIZ BORREGO RBT
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Gender | Female
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Dates
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Enumeration Date | 08/16/2021
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 1412 W WATERS AVE STE 103
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City | TAMPA
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State | FL
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Zip | 33604-2802
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Country | US
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Telephone | 813-654-7379
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Fax | 813-723-4140
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Provider Business Mailing Address
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Address Line | 12040 CORINTHIAN ST
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City | SPRING HILL
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State | FL
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Zip | 34609-5678
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Country | US
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Telephone | 813-520-5743
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-24-75091
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License Number State | FL
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