Healthcare Provider Details

I. General information

NPI: 1700624160
Provider Name (Legal Business Name): TATIANA CIFUENTES MSW, RCSWI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9296 MOSS PRESERVE PKWY APT 208
ORLANDO FL
32832-6766
US

IV. Provider business mailing address

9296 MOSS PRESERVE PKWY APT 208
ORLANDO FL
32832-6766
US

V. Phone/Fax

Practice location:
  • Phone: 754-252-3582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberISW20549
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: