Individual
CARIDAD MESA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4417 E COLONIAL DR, ORLANDO, FL 32803-5219
(407) 745-1055
Mailing address
4417 E COLONIAL DRIVE, ORLANDO, FL 32803-6194
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1-20-43884
FL
103K00000X
Behavior Analyst
Primary
RBT-18-50458
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020470300
—
FL
Enumeration date
03/14/2018
Last updated
08/19/2020
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