Healthcare Provider Details

I. General information

NPI: 1063006310
Provider Name (Legal Business Name): SCARLET CRISTINA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 W VINE ST STE 60
KISSIMMEE FL
34741-4650
US

IV. Provider business mailing address

2117 BLACKSTONE LANDING DR
KISSIMMEE FL
34758-1706
US

V. Phone/Fax

Practice location:
  • Phone: 407-559-4854
  • Fax: 321-332-7799
Mailing address:
  • Phone: 347-463-2662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: