Provider Demographics
NPI:1053183087
Name:GALVEZ, MIRZA E (BCABA)
Entity type:Individual
Prefix:MS
First Name:MIRZA
Middle Name:E
Last Name:GALVEZ
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13944 SW 104TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-3115
Mailing Address - Country:US
Mailing Address - Phone:305-505-1180
Mailing Address - Fax:
Practice Address - Street 1:13944 SW 104TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-3115
Practice Address - Country:US
Practice Address - Phone:305-505-1180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst