Healthcare Provider Details

I. General information

NPI: 1063295533
Provider Name (Legal Business Name): LORENA RODRIGUEZ DIAZ RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 NW 25TH ST STE 211
DORAL FL
33172-5927
US

IV. Provider business mailing address

10200 NW 25TH ST STE 211
DORAL FL
33172-5927
US

V. Phone/Fax

Practice location:
  • Phone: 305-381-0346
  • Fax: 305-456-0335
Mailing address:
  • Phone: 305-381-0346
  • Fax: 305-456-0335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-291690
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: