Provider Demographics
NPI:1477386944
Name:ROMERO OSPINA, SAMUEL (RBT-24-369154)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:ROMERO OSPINA
Suffix:
Gender:M
Credentials:RBT-24-369154
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2782 SUNKISSED DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-8490
Mailing Address - Country:US
Mailing Address - Phone:407-773-9366
Mailing Address - Fax:
Practice Address - Street 1:2782 SUNKISSED DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-8490
Practice Address - Country:US
Practice Address - Phone:407-773-9366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-369154106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician