MEDICARE: GUSTAVO QUEVEDO

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-25-438809	FL

General Provider Information

NPI Number	:	1558255166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUSTAVO QUEVEDO

Provider Business Mailing Address
First Line	:	7573 W 29TH LN
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-5358
Country	:	US
Telephone Number	:	305-746-8198
Fax Number	:

Provider Business Practice Location Address
First Line	:	7573 W 29TH LN
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-5358
Country	:	US
Telephone Number	:	305-746-8198
Fax Number	:

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

Provider Enumeration Date	:	06/06/2025
Last Update Date	:	06/06/2025

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Directions to “ GUSTAVO QUEVEDO ” Practice Location

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