Healthcare Provider Details

I. General information

NPI: 1265040679
Provider Name (Legal Business Name): ROLANDO HUMBERTO BETANCOURT FERIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10838 WOODBROOK CIR
LAKELAND FL
33809-1170
US

IV. Provider business mailing address

10838 WOODBROOK CIR
LAKELAND FL
33809-1170
US

V. Phone/Fax

Practice location:
  • Phone: 813-522-9625
  • Fax:
Mailing address:
  • Phone: 813-522-9625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: