Provider Demographics
NPI:1902627938
Name:DELGADO AVILA, GABRIELA (RBT)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:DELGADO AVILA
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 1:10200 WILLOWEMAC CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-4819
Mailing Address - Country:US
Mailing Address - Phone:689-808-0072
Mailing Address - Fax:
Practice Address - Street 1:1300 E MICHIGAN ST STE B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4815
Practice Address - Country:US
Practice Address - Phone:407-488-6898
Practice Address - Fax:407-988-2452
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1064726222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist