Provider Demographics
NPI:1083206049
Name:RONDA, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:RONDA
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 1:2075 SW 122ND AVE APT 220
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7336
Mailing Address - Country:US
Mailing Address - Phone:407-496-3899
Mailing Address - Fax:
Practice Address - Street 1:2075 SW 122ND AVE APT 220
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-7336
Practice Address - Country:US
Practice Address - Phone:407-496-3899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician