MEDICARE: IVETTE GOMEZ CAPOTE RBT

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	106S00000X	Behavior Technician	RBT-24-395392	FL

General Provider Information

NPI Number	:	1235936923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVETTE GOMEZ CAPOTE RBT

Provider Business Mailing Address
First Line	:	12711 SADDLE CLUB CIR APT 102
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33635-9687
Country	:	US
Telephone Number	:	786-865-4220
Fax Number	:

Provider Business Practice Location Address
First Line	:	5410 MARINER ST STE 175
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3434
Country	:	US
Telephone Number	:	813-461-5380
Fax Number	:

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

Provider Enumeration Date	:	02/28/2025
Last Update Date	:	02/28/2025

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