Healthcare Provider Details

I. General information

NPI: 1295559813
Provider Name (Legal Business Name): CINDY CUESTA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 NW SAINT LUCIE WEST BLVD STE 207
PORT ST LUCIE FL
34986-1963
US

IV. Provider business mailing address

2508 SE ANCHORAGE CV APT B-2
PORT ST LUCIE FL
34952-6212
US

V. Phone/Fax

Practice location:
  • Phone: 772-237-1731
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-390014
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: