Healthcare Provider Details

I. General information

NPI: 1871285932
Provider Name (Legal Business Name): PAOLA A RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 STIRLING RD
HOLLYWOOD FL
33024-8065
US

IV. Provider business mailing address

3210 NW 84TH WAY
PEMBROKE PINES FL
33024-5259
US

V. Phone/Fax

Practice location:
  • Phone: 954-483-1328
  • Fax:
Mailing address:
  • Phone: 954-483-1328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: