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NPI Code Detail

MEDICARE: BRENELLY RODRIGUEZ

MEDICARE: BRENELLY RODRIGUEZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1215748157
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENELLY RODRIGUEZ
Provider Business Mailing Address
First Line : 808 LOMO ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-5625
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4917 GOLDEN TRIANGLE BLVD STE 421
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-4673
Country : US
Telephone Number : 817-717-8584
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2025
Last Update Date : 01/20/2025

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Directions to “ BRENELLY RODRIGUEZ ” Practice Location

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