Provider Demographics
NPI:1851976187
Name:CARVAJAL, GABRIEL ISAIAS (COTA/L)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ISAIAS
Last Name:CARVAJAL
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 NW 218TH WAY
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-1094
Mailing Address - Country:US
Mailing Address - Phone:954-907-8525
Mailing Address - Fax:
Practice Address - Street 1:120 NW 218TH WAY
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1094
Practice Address - Country:US
Practice Address - Phone:954-907-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18199224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant