Provider Demographics
NPI:1891241436
Name:RENTERO CRESPO, VILMA MARGARITA
Entity Type:Individual
Prefix:MRS
First Name:VILMA
Middle Name:MARGARITA
Last Name:RENTERO CRESPO
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 1:2329 ACADEMY CIR E APT 108
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-8506
Mailing Address - Country:US
Mailing Address - Phone:787-240-2827
Mailing Address - Fax:
Practice Address - Street 1:3201 BUDINGER AVE.
Practice Address - Street 2:
Practice Address - City:ST. CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769
Practice Address - Country:US
Practice Address - Phone:407-910-2941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7606235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist