MEDICARE: MRS. CHANTELL A. RODRIGUEZ - DEL VALLE BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-06-3024	FL

General Provider Information

NPI Number	:	1154564854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHANTELL A. RODRIGUEZ - DEL VALLE BCBA

Provider Business Mailing Address
First Line	:	9306 BLACK THORN LOOP
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34638-2530
Country	:	US
Telephone Number	:	813-310-0011
Fax Number	:	813-793-6951

Provider Business Practice Location Address
First Line	:	9306 BLACK THORN LOOP
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34638-2530
Country	:	US
Telephone Number	:	813-310-0011
Fax Number	:	813-793-6951

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2009
Last Update Date	:	04/09/2009

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