MEDICARE: MABEL GOMEZ ALBERTUS

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	1-26-89500	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	:	1548971641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MABEL GOMEZ ALBERTUS

Provider Business Mailing Address
First Line	:	4551 HILLINGDAM RD
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-1816
Country	:	US
Telephone Number	:	863-512-4803
Fax Number	:

Provider Business Practice Location Address
First Line	:	4551 HILLINGDAM RD
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-1816
Country	:	US
Telephone Number	:	407-558-6874
Fax Number	:

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

Provider Enumeration Date	:	12/09/2022
Last Update Date	:	04/24/2026

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