Healthcare Provider Details

I. General information

NPI: 1013872126
Provider Name (Legal Business Name): JANET BALBUENA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 SE LENNARD RD # UNID102
PORT ST LUCIE FL
34952-4764
US

IV. Provider business mailing address

2045 SE LENNARD RD # UNID102
PORT ST LUCIE FL
34952-4764
US

V. Phone/Fax

Practice location:
  • Phone: 813-312-2447
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1304764
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: