MEDICARE: ROLANDO JOSUE PUPO PEREZ

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	106S00000X	Behavior Technician	RBT-24-385418	FL

General Provider Information

NPI Number	:	1164380291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROLANDO JOSUE PUPO PEREZ

Provider Business Mailing Address
First Line	:	2804 40TH ST W
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33971-0809
Country	:	US
Telephone Number	:	239-848-0440
Fax Number	:

Provider Business Practice Location Address
First Line	:	2804 40TH ST W
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33971-0809
Country	:	US
Telephone Number	:	239-848-0440
Fax Number	:

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

Provider Enumeration Date	:	01/15/2026
Last Update Date	:	01/15/2026

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Directions to “ ROLANDO JOSUE PUPO PEREZ ” Practice Location

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