Healthcare Provider Details

I. General information

NPI: 1972472454
Provider Name (Legal Business Name): DAINERY ALBERTO CRESPO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 CRYSTALVIEW TRL
LAKELAND FL
33801-6877
US

IV. Provider business mailing address

1610 CRYSTALVIEW TRL
LAKELAND FL
33801-6877
US

V. Phone/Fax

Practice location:
  • Phone: 863-602-8178
  • Fax:
Mailing address:
  • Phone: 863-602-8178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT25483333
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: