Provider Demographics
NPI:1629859020
Name:GALVEZ, CRYSTIAN (RBT-23-303030)
Entity Type:Individual
Prefix:
First Name:CRYSTIAN
Middle Name:
Last Name:GALVEZ
Suffix:
Gender:M
Credentials:RBT-23-303030
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 NW 24TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-4322
Mailing Address - Country:US
Mailing Address - Phone:786-608-6325
Mailing Address - Fax:
Practice Address - Street 1:314 NW 24TH PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993-4322
Practice Address - Country:US
Practice Address - Phone:786-608-6325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-303030106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician