Provider Demographics
NPI:1134967755
Name:REBUSTILLO, ADRIANA TERESA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:TERESA
Last Name:REBUSTILLO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 S DIXIE HWY STE 1304
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2974
Mailing Address - Country:US
Mailing Address - Phone:305-364-5680
Mailing Address - Fax:
Practice Address - Street 1:1390 S DIXIE HWY STE 1304
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2974
Practice Address - Country:US
Practice Address - Phone:305-364-5680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ11636235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist