Healthcare Provider Details

I. General information

NPI: 1225639164
Provider Name (Legal Business Name): RACHEL RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2898 NW 79TH AVE
DORAL FL
33122-1033
US

IV. Provider business mailing address

1950 NW 85TH WAY
PEMBROKE PINES FL
33024-3444
US

V. Phone/Fax

Practice location:
  • Phone: 305-597-3861
  • Fax: 305-597-3863
Mailing address:
  • Phone: 786-370-8485
  • Fax: 305-597-3863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-60908
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: