Provider Demographics
NPI:1629553292
Name:MATEO, GILBERT DELM LOPEZ
Entity Type:Individual
Prefix:
First Name:GILBERT DELM
Middle Name:LOPEZ
Last Name:MATEO
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 1:197 CRYSTAL CT
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-3815
Mailing Address - Country:US
Mailing Address - Phone:707-652-4143
Mailing Address - Fax:
Practice Address - Street 1:197 CRYSTAL CT
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-3815
Practice Address - Country:US
Practice Address - Phone:707-652-4143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-30
Last Update Date:2018-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst