Healthcare Provider Details

I. General information

NPI: 1508729104
Provider Name (Legal Business Name): BARBARA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 DOUGLAS AVE
ALTAMONTE SPRINGS FL
32714-2000
US

IV. Provider business mailing address

608 HARRISON PLACE DR APT 920
DELAND FL
32724-6994
US

V. Phone/Fax

Practice location:
  • Phone: 321-972-4265
  • Fax:
Mailing address:
  • Phone: 386-273-2480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: