Provider Demographics
NPI:1508514134
Name:SOMARRIBA, GILMA MARIA (BCABA)
Entity Type:Individual
Prefix:
First Name:GILMA
Middle Name:MARIA
Last Name:SOMARRIBA
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 SW 142ND AVE APT B109
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4003
Mailing Address - Country:US
Mailing Address - Phone:786-740-0024
Mailing Address - Fax:
Practice Address - Street 1:1185 VILLAGIO CIR UNIT 108
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-3649
Practice Address - Country:US
Practice Address - Phone:786-740-0024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-23-14802106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102955600Medicaid