Healthcare Provider Details

I. General information

NPI: 1730883877
Provider Name (Legal Business Name): AMANDA VALDES RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2119 10TH AVE N
LAKE WORTH BEACH FL
33461-3345
US

IV. Provider business mailing address

3220 DOLAN RD
PALM SPRINGS FL
33406-7924
US

V. Phone/Fax

Practice location:
  • Phone: 561-444-2814
  • Fax: 561-444-2458
Mailing address:
  • Phone: 561-358-0354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-264501
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: