Healthcare Provider Details

I. General information

NPI: 1831860667
Provider Name (Legal Business Name): JESSICA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N PARK RD STE 400
HOLLYWOOD FL
33021-6918
US

IV. Provider business mailing address

748 E 41ST ST
HIALEAH FL
33013-2347
US

V. Phone/Fax

Practice location:
  • Phone: 954-925-3191
  • Fax:
Mailing address:
  • Phone: 305-632-6360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-163568
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: