Provider Demographics
NPI:1013579333
Name:PLATA, JOSEFINA
Entity Type:Individual
Prefix:
First Name:JOSEFINA
Middle Name:
Last Name:PLATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13245 SANCTUARY COVE DR UNIT 201
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-2120
Mailing Address - Country:US
Mailing Address - Phone:813-304-5147
Mailing Address - Fax:
Practice Address - Street 1:300 INTERNATIONAL PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5028
Practice Address - Country:US
Practice Address - Phone:813-862-3743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician