Healthcare Provider Details

I. General information

NPI: 1083203780
Provider Name (Legal Business Name): MARLENES ALMANZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2021
Last Update Date: 01/16/2021
Certification Date: 01/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3413 16TH ST W
LEHIGH ACRES FL
33971-5329
US

IV. Provider business mailing address

3413 16TH ST W
LEHIGH ACRES FL
33971-5329
US

V. Phone/Fax

Practice location:
  • Phone: 786-227-2003
  • Fax:
Mailing address:
  • Phone: 786-227-2003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberRBT-20-140871
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: