Provider Demographics
NPI:1437712023
Name:FERNANDEZ VALLEJO, ROCIO
Entity Type:Individual
Prefix:
First Name:ROCIO
Middle Name:
Last Name:FERNANDEZ VALLEJO
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 1:4711 W WATERS AVE APT 811
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1475
Mailing Address - Country:US
Mailing Address - Phone:813-775-8350
Mailing Address - Fax:
Practice Address - Street 1:4711 W WATERS AVE APT 811
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1475
Practice Address - Country:US
Practice Address - Phone:813-775-8350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician