Healthcare Provider Details

I. General information

NPI: 1316641186
Provider Name (Legal Business Name): JACINTO ENRIQUE ROSALES RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 SW 6TH AVE
CAPE CORAL FL
33991-3420
US

IV. Provider business mailing address

1610 SW 6TH AVE
CAPE CORAL FL
33991-3420
US

V. Phone/Fax

Practice location:
  • Phone: 786-255-8155
  • Fax:
Mailing address:
  • Phone: 786-255-8155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2853433
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: