Individual
AMBAR DIANETH RODRIGUEZ-MANCILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1216 PATRICK ST, KISSIMMEE, FL 34741-5534
(407) 329-3464
Mailing address
10136 TIERRA BELLA DR, ORLANDO, FL 32825-7703
(407) 274-1120
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-24-70809
FL
103K00000X
Behavior Analyst
—
—
222Q00000X
Developmental Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108221600
—
FL
Enumeration date
08/31/2016
Last updated
01/15/2025
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