Healthcare Provider Details

I. General information

NPI: 1285348995
Provider Name (Legal Business Name): RUTHETTA PENDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 NORTHLAKE BLVD APT 59
ALTAMONTE SPRINGS FL
32701-6161
US

IV. Provider business mailing address

605 NORTHLAKE BLVD APT 59
ALTAMONTE SPRINGS FL
32701-6161
US

V. Phone/Fax

Practice location:
  • Phone: 75-800-4894
  • Fax:
Mailing address:
  • Phone: 407-580-0489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: