Healthcare Provider Details

I. General information

NPI: 1326893751
Provider Name (Legal Business Name): ROSANGELA CUETO GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11826 HULLBRIDGE CT
ORLANDO FL
32837-5727
US

IV. Provider business mailing address

11826 HULLBRIDGE CT
ORLANDO FL
32837-5727
US

V. Phone/Fax

Practice location:
  • Phone: 727-358-3587
  • Fax:
Mailing address:
  • Phone: 727-358-3587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-337525
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: