Active NPI
Raquel Enid Medina Roldan, RBT-24-391837
- Behavior Technician
- Winter Haven, FL
National Provider Identifier
1699582296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-24-391837
- Practice address
- 309 Gretna LN
Winter Haven, FL 33880-6179 - Phone
- (787) 394-9221
- NPI assigned
- Dec 17, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-24-391837 | FL | Primary |
Addresses
Primary practice location
309 Gretna LN
Winter Haven, FL 33880-6179
Mailing address
309 Gretna LN
Winter Haven, FL 33880-6179
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-24-391837 | FL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1734393600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737504000000",
"number": "1699582296",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "309 GRETNA LN",
"city": "WINTER HAVEN",
"state": "FL",
"postal_code": "338806179"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "309 GRETNA LN",
"city": "WINTER HAVEN",
"state": "FL",
"postal_code": "338806179",
"telephone_number": "787-394-9221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA ROLDAN",
"first_name": "RAQUEL",
"middle_name": "ENID",
"credential": "RBT-24-391837",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-12-17",
"last_updated": "2025-01-22",
"certification_date": "2025-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "RBT-24-391837",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winter Haven, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.