Individual
JUAN GORDILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
2916 SUMMIT DR, FULTONDALE, AL 35068-6025
(256) 457-8668
Mailing address
2916 SUMMIT DR, FULTONDALE, AL 35068-6025
(256) 457-8668
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-183959
AL
Other
Enumeration date
09/17/2021
Last updated
09/17/2021
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