Provider Demographics
NPI:1265040679
Name:BETANCOURT FERIA, ROLANDO HUMBERTO
Entity type:Individual
Prefix:
First Name:ROLANDO
Middle Name:HUMBERTO
Last Name:BETANCOURT FERIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10838 WOODBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-1170
Mailing Address - Country:US
Mailing Address - Phone:813-522-9625
Mailing Address - Fax:
Practice Address - Street 1:10838 WOODBROOK CIR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-1170
Practice Address - Country:US
Practice Address - Phone:813-522-9625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X, 374U00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No374U00000XNursing Service Related ProvidersHome Health Aide
No253Z00000XAgenciesIn Home Supportive Care