Provider Demographics
NPI:1710759568
Name:GUTIERREZ VILLANUEVA, ABEL ENRIQUE
Entity Type:Individual
Prefix:
First Name:ABEL
Middle Name:ENRIQUE
Last Name:GUTIERREZ VILLANUEVA
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 1:28802 SW 160TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-1162
Mailing Address - Country:US
Mailing Address - Phone:305-812-6509
Mailing Address - Fax:
Practice Address - Street 1:28802 SW 160TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-1162
Practice Address - Country:US
Practice Address - Phone:305-812-6509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-283739106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician