Provider Demographics
NPI:1548328529
Name:ALVARADO-GUILLEN, GISELLE ANNABELLE
Entity type:Individual
Prefix:
First Name:GISELLE
Middle Name:ANNABELLE
Last Name:ALVARADO-GUILLEN
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 1:1121 28TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-4554
Mailing Address - Country:US
Mailing Address - Phone:239-777-7088
Mailing Address - Fax:
Practice Address - Street 1:1121 28TH AVE N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4554
Practice Address - Country:US
Practice Address - Phone:239-777-7088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811728400Medicaid