Healthcare Provider Details

I. General information

NPI: 1972951564
Provider Name (Legal Business Name): MELISSA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 NW 24TH ST
CORAL SPRINGS FL
33065-3645
US

IV. Provider business mailing address

11100 NW 24TH ST
CORAL SPRINGS FL
33065-3645
US

V. Phone/Fax

Practice location:
  • Phone: 786-202-0414
  • Fax:
Mailing address:
  • Phone: 786-202-0414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1262833235
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: