Provider Demographics
NPI:1508565029
Name:CERVERA GOMEZ, GABRIEL ALEJANDRO
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ALEJANDRO
Last Name:CERVERA GOMEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17710 NW 67TH AVE APT 316
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5808
Mailing Address - Country:US
Mailing Address - Phone:786-910-4968
Mailing Address - Fax:
Practice Address - Street 1:17710 NW 67TH AVE APT 316
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5808
Practice Address - Country:US
Practice Address - Phone:786-910-4968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician