Provider Demographics
NPI:1043746399
Name:ECHEVERRIA, GAELU JANICE
Entity type:Individual
Prefix:
First Name:GAELU
Middle Name:JANICE
Last Name:ECHEVERRIA
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 1:4602 CREW CIR APT 8
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-8441
Mailing Address - Country:US
Mailing Address - Phone:305-510-2367
Mailing Address - Fax:
Practice Address - Street 1:4602 CREW CIR APT 8
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-8441
Practice Address - Country:US
Practice Address - Phone:321-522-7011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-05
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker