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General NPI Number Information
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NPI Number | 1073285854
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Entity Type | Individual
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Provider Name | MARIELYS RODRIGUEZ FONSECA
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Gender | Female
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Dates
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Enumeration Date | 09/30/2021
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Last Update Date | 09/30/2021
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Provider Practice Location Address
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Address Line | 2151 CONSULATE DR STE 11
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City | ORLANDO
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State | FL
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Zip | 32837-8806
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Country | US
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Telephone | 386-362-3926
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Fax | 407-641-9591
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Provider Business Mailing Address
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Address Line | 247 CORALWOOD CT
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City | KISSIMMEE
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State | FL
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Zip | 34743-8353
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Country | US
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Telephone | 407-218-1583
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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