Provider Demographics
NPI:1912672429
Name:RUIZ BORREGO, GISELLE B (RBT)
Entity type:Individual
Prefix:
First Name:GISELLE
Middle Name:B
Last Name:RUIZ BORREGO
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 1:12040 CORINTHIAN ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5678
Mailing Address - Country:US
Mailing Address - Phone:813-520-5743
Mailing Address - Fax:
Practice Address - Street 1:1412 W WATERS AVE STE 103
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-2802
Practice Address - Country:US
Practice Address - Phone:813-654-7379
Practice Address - Fax:813-723-4140
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL1-24-75091103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician