Healthcare Provider Details

I. General information

NPI: 1043134216
Provider Name (Legal Business Name): MARY ROSE MARJORIE DAVID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4718 NARA VISTA WAY UNIT 202
LAS VEGAS NV
89103-4722
US

IV. Provider business mailing address

7108 S KANNER HWY
STUART FL
34997-7462
US

V. Phone/Fax

Practice location:
  • Phone: 407-874-3916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT6805
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: