MEDICARE: MR. FIDEL SIMON GABOTE GARCIA

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	106E00000X	Assistant Behavior Analyst
2	363LF0000X	Family Nurse Practitioner	APRN11028129	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	:	1538631387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FIDEL SIMON GABOTE GARCIA

Provider Business Mailing Address
First Line	:	4610 SW 112TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-5560
Country	:	US
Telephone Number	:	786-870-2189
Fax Number	:

Provider Business Practice Location Address
First Line	:	4610 SW 112TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-5560
Country	:	US
Telephone Number	:	786-870-2189
Fax Number	:

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

Provider Enumeration Date	:	12/18/2018
Last Update Date	:	05/27/2025

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