Provider Demographics
NPI:1033976022
Name:PADRON JEREZ, ROSALI (RBT)
Entity Type:Individual
Prefix:
First Name:ROSALI
Middle Name:
Last Name:PADRON JEREZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:ROSALI
Other - Middle Name:
Other - Last Name:PADRON JEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:7441 AVENIDA 114
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773
Mailing Address - Country:US
Mailing Address - Phone:727-492-5369
Mailing Address - Fax:727-544-5900
Practice Address - Street 1:7441 AVENIDA 114
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773
Practice Address - Country:US
Practice Address - Phone:727-492-5369
Practice Address - Fax:727-544-5900
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-330422106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician