Provider Demographics
NPI:1770233504
Name:BOSCH, ODETH BECERRA
Entity Type:Individual
Prefix:
First Name:ODETH
Middle Name:BECERRA
Last Name:BOSCH
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 1:4088 2ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-9074
Mailing Address - Country:US
Mailing Address - Phone:239-692-1544
Mailing Address - Fax:
Practice Address - Street 1:4088 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34120-9074
Practice Address - Country:US
Practice Address - Phone:239-692-1544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician