MEDICARE: GILBERTO DELGADO PANTOJA

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
2	106S00000X	Behavior Technician		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	:	1487324935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GILBERTO DELGADO PANTOJA

Provider Business Mailing Address
First Line	:	4195 W 5TH LN
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3809
Country	:	US
Telephone Number	:	786-387-2303
Fax Number	:

Provider Business Practice Location Address
First Line	:	4195 W 5TH LN
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3809
Country	:	US
Telephone Number	:	786-387-2306
Fax Number	:

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

Provider Enumeration Date	:	09/16/2021
Last Update Date	:	09/16/2021

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Directions to “ GILBERTO DELGADO PANTOJA ” Practice Location

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