Provider Demographics
NPI:1982221792
Name:GALLIGUEZ, GIZELLE
Entity Type:Individual
Prefix:
First Name:GIZELLE
Middle Name:
Last Name:GALLIGUEZ
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 1:3609 DATA DR APT 203
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-6156
Mailing Address - Country:US
Mailing Address - Phone:786-516-8710
Mailing Address - Fax:
Practice Address - Street 1:3609 DATA DR APT 203
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-6156
Practice Address - Country:US
Practice Address - Phone:786-516-8710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20802225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics