Healthcare Provider Details

I. General information

NPI: 1780308882
Provider Name (Legal Business Name): CRISTINA GUZMAN PONS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 CORONADO PKWY UNIT 101A
NAPLES FL
34116-6885
US

IV. Provider business mailing address

5301 CORONADO PKWY UNIT 101A
NAPLES FL
34116-6885
US

V. Phone/Fax

Practice location:
  • Phone: 305-414-9329
  • Fax:
Mailing address:
  • Phone: 305-414-9329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number115380100
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-24-15465
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: