Provider Demographics
NPI:1386158251
Name:GARCIA GOMEZ, CLAUDIA MARIA (RBT)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:MARIA
Last Name:GARCIA GOMEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7524 HISPANOLA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4120
Mailing Address - Country:US
Mailing Address - Phone:305-335-4284
Mailing Address - Fax:
Practice Address - Street 1:7524 HISPANOLA AVE
Practice Address - Street 2:
Practice Address - City:NORTH BAY VILLAGE
Practice Address - State:FL
Practice Address - Zip Code:33141
Practice Address - Country:US
Practice Address - Phone:305-335-4284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-18-58803106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-18-58803OtherBEHAVIOR ANALYST CERTIFICATION BOARD
FL023112400Medicaid