Provider Demographics
NPI:1881233641
Name:OQUENDO, NELITZA NICOLE
Entity type:Individual
Prefix:
First Name:NELITZA
Middle Name:NICOLE
Last Name:OQUENDO
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 1:2896 MATERA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-9132
Mailing Address - Country:US
Mailing Address - Phone:407-488-3350
Mailing Address - Fax:
Practice Address - Street 1:2896 MATERA DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-9132
Practice Address - Country:US
Practice Address - Phone:407-488-3350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty