Provider Demographics
NPI:1518756212
Name:MORENO LOPEZ, GILDA D
Entity type:Individual
Prefix:
First Name:GILDA
Middle Name:D
Last Name:MORENO LOPEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 NW EMBERS TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-7756
Mailing Address - Country:US
Mailing Address - Phone:239-222-0767
Mailing Address - Fax:
Practice Address - Street 1:2977 GOODLETTE-FRANK RD N STE 14
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4613
Practice Address - Country:US
Practice Address - Phone:786-451-5307
Practice Address - Fax:239-237-5981
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-430144106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician