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General NPI Number Information
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NPI Number | 1700747193
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Entity Type | Individual
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Provider Name | SOFIA VALENTINA FREDERICK-PUENTE RBT
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Gender | Female
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 1603 S HIAWASSEE RD STE 110
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City | ORLANDO
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State | FL
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Zip | 32835-6437
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Country | US
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Telephone | 321-209-2933
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Fax | 407-270-8389
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Provider Business Mailing Address
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Address Line | 12104 GREEN BADGER LN APT 1193
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City | ORLANDO
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State | FL
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Zip | 32817-3568
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Country | US
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Telephone | 561-453-5077
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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 | BACB1461727
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License Number State | FL
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