MEDICARE: CRYSTIAN GALVEZ BCABA 0-26-17073

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	BCABA02617073	FL

General Provider Information

NPI Number	:	1629859020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTIAN GALVEZ BCABA 0-26-17073

Provider Business Mailing Address
First Line	:	314 NW 24TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33993-4322
Country	:	US
Telephone Number	:	786-608-6325
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 NW 24TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33993-4322
Country	:	US
Telephone Number	:	786-608-6325
Fax Number	:

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

Provider Enumeration Date	:	10/11/2023
Last Update Date	:	04/15/2026

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