Healthcare Provider Details

I. General information

NPI: 1942923966
Provider Name (Legal Business Name): YENIDY RONDAN GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 NORTH AVE
LEHIGH ACRES FL
33972-2117
US

IV. Provider business mailing address

1404 NORTH AVE
LEHIGH ACRES FL
33972-2117
US

V. Phone/Fax

Practice location:
  • Phone: 702-344-4602
  • Fax:
Mailing address:
  • Phone: 702-344-4602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2831829
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: