Provider Demographics
NPI:1033990635
Name:GALAN GOMEZ, MAYTEE
Entity Type:Individual
Prefix:
First Name:MAYTEE
Middle Name:
Last Name:GALAN GOMEZ
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 1:8534 NW 115TH CT
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2001
Mailing Address - Country:US
Mailing Address - Phone:786-803-3233
Mailing Address - Fax:
Practice Address - Street 1:8534 NW 115TH CT
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2001
Practice Address - Country:US
Practice Address - Phone:786-803-3233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-299712106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician