Healthcare Provider Details

I. General information

NPI: 1356850093
Provider Name (Legal Business Name): JILLIAN ALEXA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 OAKWOOD BLVD
HOLLYWOOD FL
33020-1956
US

IV. Provider business mailing address

18712 NW 84TH PL APT 306
HIALEAH FL
33015-2591
US

V. Phone/Fax

Practice location:
  • Phone: 954-925-3844
  • Fax:
Mailing address:
  • Phone: 786-325-2439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA16664
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: