MEDICARE: GISELLE GONZALEZ QUEVEDO RODRIGUEZ

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	23290231

General Provider Information

NPI Number	:	1619741535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GISELLE GONZALEZ QUEVEDO RODRIGUEZ

Provider Business Mailing Address
First Line	:	7927 W 2ND CT APT 205
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-4337
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7927 W 2ND CT APT 205
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-4337
Country	:	US
Telephone Number	:	786-631-0722
Fax Number	:

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

Provider Enumeration Date	:	11/10/2023
Last Update Date	:	11/10/2023

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Directions to “ GISELLE GONZALEZ QUEVEDO RODRIGUEZ ” Practice Location

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