Provider Demographics
NPI:1205382348
Name:HERNANDEZ GAMBOA, MARBELIA
Entity Type:Individual
Prefix:
First Name:MARBELIA
Middle Name:
Last Name:HERNANDEZ GAMBOA
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 1:1706 W 66TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6164
Mailing Address - Country:US
Mailing Address - Phone:786-286-0711
Mailing Address - Fax:
Practice Address - Street 1:1706 W 66TH PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6164
Practice Address - Country:US
Practice Address - Phone:786-286-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BCBA-1-21-53375103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst