Provider Demographics
NPI:1124640453
Name:GALA IGLESIA, DAVID (RMHCI)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GALA IGLESIA
Suffix:
Gender:M
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12018 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3728
Mailing Address - Country:US
Mailing Address - Phone:786-440-2288
Mailing Address - Fax:
Practice Address - Street 1:12018 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-3728
Practice Address - Country:US
Practice Address - Phone:786-440-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25363101YM0800X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health