Provider Demographics
NPI:1366026577
Name:FERNANDEZ BATISTA, ODALIS (RBT)
Entity Type:Individual
Prefix:
First Name:ODALIS
Middle Name:
Last Name:FERNANDEZ BATISTA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5814 N CAMERON AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-5508
Mailing Address - Country:US
Mailing Address - Phone:813-557-1525
Mailing Address - Fax:
Practice Address - Street 1:5814 N CAMERON AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5508
Practice Address - Country:US
Practice Address - Phone:813-557-1525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician