Provider Demographics
NPI:1578371266
Name:GUTIERREZ DE LEON, GABRIELA VIRGINIA
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:VIRGINIA
Last Name:GUTIERREZ DE LEON
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 1:9243 W 34TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-2054
Mailing Address - Country:US
Mailing Address - Phone:786-832-7317
Mailing Address - Fax:
Practice Address - Street 1:9243 W 34TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-2054
Practice Address - Country:US
Practice Address - Phone:786-832-7317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-26
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLG246-270-13-600-0106S00000X
FLRBT-24-396129103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician