Healthcare Provider Details

I. General information

NPI: 1396521316
Provider Name (Legal Business Name): MABEL GUTIERREZ RODRIGUEZ RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5221 W 25TH CT
HIALEAH FL
33016-4072
US

IV. Provider business mailing address

5221 W 25TH CT
HIALEAH FL
33016-4072
US

V. Phone/Fax

Practice location:
  • Phone: 786-813-1511
  • Fax:
Mailing address:
  • Phone: 786-813-1511
  • Fax: 786-813-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number23-275528
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: