Healthcare Provider Details

I. General information

NPI: 1104733823
Provider Name (Legal Business Name): MS. KYSBEL CESARINA ROSA-RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 PINE RIDGE DRIVE
DAVENPORT FL
33896
UM

IV. Provider business mailing address

1102 PINE RIDGE DR
DAVENPORT FL
33896-4734
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 407-219-0402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: