Healthcare Provider Details

I. General information

NPI: 1447674205
Provider Name (Legal Business Name): MRS. MARIOLA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1463 OAKFIELD DR STE 130
BRANDON FL
33511-0802
US

IV. Provider business mailing address

1463 OAKFIELD DR STE 130
BRANDON FL
33511-0802
US

V. Phone/Fax

Practice location:
  • Phone: 813-655-4166
  • Fax:
Mailing address:
  • Phone: 813-655-4166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number5572
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: