Healthcare Provider Details

I. General information

NPI: 1588017982
Provider Name (Legal Business Name): DELKIS DIEGUEZ CANTALLOPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 SW 37TH LN
CAPE CORAL FL
33914-7859
US

IV. Provider business mailing address

236 SW 37TH LN
CAPE CORAL FL
33914-7859
US

V. Phone/Fax

Practice location:
  • Phone: 786-312-9778
  • Fax:
Mailing address:
  • Phone: 786-312-9778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-57956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: