Basic Information
| Provider Information | |||||||||
| NPI: | 1891241436 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RENTERO CRESPO | ||||||||
| FirstName: | VILMA | ||||||||
| MiddleName: | MARGARITA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2329 ACADEMY CIR E APT 108 | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347448506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872402827 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3201 BUDINGER AVE. | ||||||||
| Address2: | |||||||||
| City: | ST. CLOUD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079102941 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2016 | ||||||||
| LastUpdateDate: | 10/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SZ7606 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.