Provider Demographics
NPI:1467107367
Name:GARGICEVICH MARTINS DE ALMEIDA, BIANCA (RBT)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:GARGICEVICH MARTINS DE ALMEIDA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:
Other - Last Name:GARGICEVICH ALMEIDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2810 KEATS ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-2303
Mailing Address - Country:US
Mailing Address - Phone:951-255-3979
Mailing Address - Fax:
Practice Address - Street 1:2445 TRUXTUN RD STE 205
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-6154
Practice Address - Country:US
Practice Address - Phone:619-633-2119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
RBT-23-263731106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician