Provider Demographics
NPI:1487406575
Name:RODRIGUEZ BUSTO, MARIA KARLA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:KARLA
Last Name:RODRIGUEZ BUSTO
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 1:14926 GLASGOW CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-2058
Mailing Address - Country:US
Mailing Address - Phone:813-543-7111
Mailing Address - Fax:
Practice Address - Street 1:14926 GLASGOW CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-2058
Practice Address - Country:US
Practice Address - Phone:813-543-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-332759106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician