MEDICARE: GISSELLE ELLIANA GALLO HERNANDEZ

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-24336218	FL

General Provider Information

NPI Number	:	1902659790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GISSELLE ELLIANA GALLO HERNANDEZ

Provider Business Mailing Address
First Line	:	6105 W 14TH CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-6248
Country	:	US
Telephone Number	:	786-737-5774
Fax Number	:

Provider Business Practice Location Address
First Line	:	6105 W 14TH CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-6248
Country	:	US
Telephone Number	:	786-737-5774
Fax Number	:

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

Provider Enumeration Date	:	04/10/2024
Last Update Date	:	04/10/2024

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Directions to “ GISSELLE ELLIANA GALLO HERNANDEZ ” Practice Location

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