MEDICARE: DANIELA VALDES RODRIGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	24398186	FL

General Provider Information

NPI Number	:	1710795711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELA VALDES RODRIGUEZ

Provider Business Mailing Address
First Line	:	17387 W CARNEGIE CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33967-5852
Country	:	US
Telephone Number	:	239-227-5155
Fax Number	:

Provider Business Practice Location Address
First Line	:	17387 W CARNEGIE CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33967-5852
Country	:	US
Telephone Number	:	239-227-5155
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2024
Last Update Date	:	12/21/2024

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