Healthcare Provider Details

I. General information

NPI: 1821947896
Provider Name (Legal Business Name): ELSA DAMARIS RODRIGUEZ CHAMIZO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10493 IRELAND ST
SPRING HILL FL
34608-4133
US

IV. Provider business mailing address

10493 IRELAND ST
SPRING HILL FL
34608-4133
US

V. Phone/Fax

Practice location:
  • Phone: 727-597-2004
  • Fax:
Mailing address:
  • Phone: 727-597-2004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT26509163
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: