MEDICARE: ESTELA M GOMEZ VIZCAINO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-23-66070	FL
2	106S00000X	Behavior Technician	RBT-20-142703	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144821869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTELA M GOMEZ VIZCAINO

Provider Business Mailing Address
First Line	:	500 VILLAGE GREEN CIR W APT D311
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-1452
Country	:	US
Telephone Number	:	561-229-2649
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 VILLAGE GREEN CIR W APT D311
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-1452
Country	:	US
Telephone Number	:	561-229-2649
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2020
Last Update Date	:	08/08/2023

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