MEDICARE: GISELLE B RUIZ BORREGO RBT

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
2	103K00000X	Behavior Analyst	1-24-75091	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	:	1912672429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GISELLE B RUIZ BORREGO RBT

Provider Business Mailing Address
First Line	:	12040 CORINTHIAN ST
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-5678
Country	:	US
Telephone Number	:	813-520-5743
Fax Number	:

Provider Business Practice Location Address
First Line	:	1412 W WATERS AVE STE 103
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-2802
Country	:	US
Telephone Number	:	813-654-7379
Fax Number	:	813-723-4140

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

Provider Enumeration Date	:	08/16/2021
Last Update Date	:	08/22/2024

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Directions to “ GISELLE B RUIZ BORREGO RBT” Practice Location

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