Provider Demographics
NPI:1023618949
Name:VEIGA IPARRAGUIRRE, GERARDO
Entity type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:VEIGA IPARRAGUIRRE
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 1:7180 NW 179TH ST APT 206
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5491
Mailing Address - Country:US
Mailing Address - Phone:561-542-3133
Mailing Address - Fax:
Practice Address - Street 1:7180 NW 179TH ST APT 206
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5491
Practice Address - Country:US
Practice Address - Phone:561-542-3133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV216280934540OtherDL