Healthcare Provider Details

I. General information

NPI: 1114757887
Provider Name (Legal Business Name): DIANA ROSA MARTIN SOSPEDRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25050 SANDHILL BLVD APT 2B1
PUNTA GORDA FL
33983-7921
US

IV. Provider business mailing address

25050 SANDHILL BLVD APT 2B1
PUNTA GORDA FL
33983-7921
US

V. Phone/Fax

Practice location:
  • Phone: 786-427-7737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-16828
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: