Healthcare Provider Details

I. General information

NPI: 1861262362
Provider Name (Legal Business Name): MRS. GLENIAR FERNANDEZ CAMALLERE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 SAND LAKE RD STE 176
ORLANDO FL
32809-7747
US

IV. Provider business mailing address

5149 VISTA LAGO DR
ORLANDO FL
32811-8310
US

V. Phone/Fax

Practice location:
  • Phone: 407-214-5539
  • Fax:
Mailing address:
  • Phone: 407-984-8306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90039
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: