Healthcare Provider Details

I. General information

NPI: 1093406068
Provider Name (Legal Business Name): DEBORAH JANERA OQUENDO RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 WILLOW DR
ORLANDO FL
32807-3220
US

IV. Provider business mailing address

1932 LAKE ATRIUMS CIRCLE APT 81 1932 LAKE ATRIUMS CIRCLE # 81
ORLANDO FL
32839
US

V. Phone/Fax

Practice location:
  • Phone: 407-895-0801
  • Fax:
Mailing address:
  • Phone: 407-449-3869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-274314
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: