Provider Demographics
NPI:1730652975
Name:BORRAS, GILDA IVELISSE
Entity Type:Individual
Prefix:
First Name:GILDA
Middle Name:IVELISSE
Last Name:BORRAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 INTEGRA MEADOWS DR APT 103
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-7814
Mailing Address - Country:US
Mailing Address - Phone:787-929-6199
Mailing Address - Fax:
Practice Address - Street 1:809 E OAK ST STE 105
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5834
Practice Address - Country:US
Practice Address - Phone:407-483-9520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-19-75194OtherBEHAVIOR ANALYSIS CERTIFICATION BOARD