Healthcare Provider Details

I. General information

NPI: 1285445726
Provider Name (Legal Business Name): ROCIO E FUENTES SANDOVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2677 FOREST HILL BLVD STE 109
WEST PALM BEACH FL
33406-5941
US

IV. Provider business mailing address

207 WATERWAY VILLAGE CT
GREENACRES FL
33413-2163
US

V. Phone/Fax

Practice location:
  • Phone: 561-433-5050
  • Fax:
Mailing address:
  • Phone: 561-480-5482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-403850
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: