Individual
AMANDA MARIA MEDINA LACOBA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2747 NE 5TH AVE, CAPE CORAL, FL 33909-8840
(786) 830-1038
Mailing address
2747 NE 5TH AVE, CAPE CORAL, FL 33909-8840
(786) 830-1038
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-277640
FL
Other
Enumeration date
06/28/2023
Last updated
07/08/2025
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