Healthcare Provider Details

I. General information

NPI: 1396438230
Provider Name (Legal Business Name): DIANILE ALFONSO RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 SE 4TH ST
HIALEAH FL
33010-5317
US

IV. Provider business mailing address

551 SE 4TH ST
HIALEAH FL
33010-5317
US

V. Phone/Fax

Practice location:
  • Phone: 954-995-2683
  • Fax:
Mailing address:
  • Phone: 954-995-2683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2827451
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: