Provider Demographics
NPI:1366181653
Name:ACEVEDO-RODRIGUEZ, NATALIE CRISTINA
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:CRISTINA
Last Name:ACEVEDO-RODRIGUEZ
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 1:3760 METRO PKWY APT 617
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-7495
Mailing Address - Country:US
Mailing Address - Phone:787-218-5454
Mailing Address - Fax:
Practice Address - Street 1:3760 METRO PKWY APT 617
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-7495
Practice Address - Country:US
Practice Address - Phone:787-218-5454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22-214865106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty