Provider Demographics
NPI:1790338945
Name:GALLARDO-GONZALEZ, MARIA DE LOS ANGELES (MA, MS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:DE LOS ANGELES
Last Name:GALLARDO-GONZALEZ
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Gender:F
Credentials:MA, MS, BCBA
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Mailing Address - Street 1:300 INTERNATIONAL PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5028
Mailing Address - Country:US
Mailing Address - Phone:407-915-7729
Mailing Address - Fax:407-588-6294
Practice Address - Street 1:10920 MOSS PARK RD STE 130
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6087
Practice Address - Country:US
Practice Address - Phone:407-930-4339
Practice Address - Fax:407-745-0316
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2023-08-15
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Provider Licenses
StateLicense IDTaxonomies
FL1-22-59999103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104278900Medicaid