Healthcare Provider Details

I. General information

NPI: 1508513912
Provider Name (Legal Business Name): THALIANA CHEYANN RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 NW 25TH ST STE 204
DORAL FL
33172-5922
US

IV. Provider business mailing address

8235 PARK BLVD APT 2209
MIAMI FL
33126-8031
US

V. Phone/Fax

Practice location:
  • Phone: 305-406-3689
  • Fax:
Mailing address:
  • Phone: 305-588-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-25-16539
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: