Provider Demographics
NPI:1538570932
Name:GALVEZ, GUSTAVO A
Entity type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:A
Last Name:GALVEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 S SEMORAN BLVD STE 1448
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-5508
Mailing Address - Country:US
Mailing Address - Phone:407-397-3000
Mailing Address - Fax:
Practice Address - Street 1:1300 S DUNCAN DR
Practice Address - Street 2:BUILDING C
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4223
Practice Address - Country:US
Practice Address - Phone:352-742-9999
Practice Address - Fax:352-748-9899
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH10013101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health