Healthcare Provider Details

I. General information

NPI: 1588442735
Provider Name (Legal Business Name): ADRIALYS BAEZ MARRERO RBT-20-135334
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 COLLEGE PKWY STE 107
FORT MYERS FL
33919-4111
US

IV. Provider business mailing address

2933 SE 20TH AVE
CAPE CORAL FL
33904-4076
US

V. Phone/Fax

Practice location:
  • Phone: 239-360-7963
  • Fax:
Mailing address:
  • Phone: 786-908-4018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-135334
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: