Healthcare Provider Details

I. General information

NPI: 1063137636
Provider Name (Legal Business Name): ADRIANA CONGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 GOODLETTE-FRANK RD N
NAPLES FL
34102-5614
US

IV. Provider business mailing address

10620 NOAHS CIR APT 706
NAPLES FL
34116-8367
US

V. Phone/Fax

Practice location:
  • Phone: 239-316-7656
  • Fax:
Mailing address:
  • Phone: 239-276-4142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: