Provider Demographics
NPI:1316455744
Name:GOMEZ DEL VALLIN, MAIBEL D
Entity type:Individual
Prefix:
First Name:MAIBEL
Middle Name:D
Last Name:GOMEZ DEL VALLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 SW 8TH ST STE 308
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4132
Mailing Address - Country:US
Mailing Address - Phone:305-262-5346
Mailing Address - Fax:
Practice Address - Street 1:8730 SW 133RD AVENUE RD APT 317
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183
Practice Address - Country:US
Practice Address - Phone:954-394-4084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician