Healthcare Provider Details

I. General information

NPI: 1265241921
Provider Name (Legal Business Name): MANUEL CID RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 FARRAGUT ST
HOLLYWOOD FL
33024-2716
US

IV. Provider business mailing address

7450 FARRAGUT ST
HOLLYWOOD FL
33024-2716
US

V. Phone/Fax

Practice location:
  • Phone: 754-275-5303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-400413
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: