Healthcare Provider Details

I. General information

NPI: 1104758622
Provider Name (Legal Business Name): MARIA ALTAGRACIA PENA DE ROSARIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3019 NEEDLES DR
ORLANDO FL
32810-2314
US

IV. Provider business mailing address

3019 NEEDLES DR
ORLANDO FL
32810-2314
US

V. Phone/Fax

Practice location:
  • Phone: 787-429-3116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberRN9462012
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: