Active NPI
Bianka Vanessa Gomez, RBT-18-68064
- Behavior Technician
- Kissimmee, FL
National Provider Identifier
1063988079
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-18-68064
- Practice address
- 4128 Wellington Woods Cir Apt 104
Kissimmee, FL 34741-2763 - Phone
- (863) 254-8644
- NPI assigned
- Oct 17, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-18-68064 | FL | Primary |
Addresses
Primary practice location
4128 Wellington Woods Cir Apt 104
Kissimmee, FL 34741-2763
Mailing address
4128 Wellington Woods Cir Apt 104
Kissimmee, FL 34741-2763
Phone (863) 254-8644
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 022729200 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-18-68064 | FL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1539734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539734400000",
"number": "1063988079",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4128 WELLINGTON WOODS CIR APT 104",
"city": "KISSIMMEE",
"state": "FL",
"postal_code": "347412763",
"telephone_number": "863-254-8644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4128 WELLINGTON WOODS CIR APT 104",
"city": "KISSIMMEE",
"state": "FL",
"postal_code": "347412763",
"telephone_number": "863-254-8644"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOMEZ",
"first_name": "BIANKA",
"middle_name": "VANESSA",
"credential": "RBT-18-68064",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-10-17",
"last_updated": "2018-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Behavior Technician",
"state": "FL",
"license": "RBT-18-68064",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "022729200",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kissimmee, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.