MEDICARE: GISELA D SARDINAS LOPEZ

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	106S00000X	Behavior Technician
3	103K00000X	Behavior Analyst	1-23-65105	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	:	1740710946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GISELA D SARDINAS LOPEZ

Provider Business Mailing Address
First Line	:	2717 SW 37TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-4860
Country	:	US
Telephone Number	:	786-616-7539
Fax Number	:

Provider Business Practice Location Address
First Line	:	2717 SW 37TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-4860
Country	:	US
Telephone Number	:	786-616-7539
Fax Number	:

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

Provider Enumeration Date	:	06/20/2017
Last Update Date	:	08/25/2025

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