Healthcare Provider Details

I. General information

NPI: 1336852052
Provider Name (Legal Business Name): TAMARA RODRIGUEZ RBT-22-250646
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 GREENBRIAR BLVD
LEHIGH ACRES FL
33972-1106
US

IV. Provider business mailing address

471 GREENBRIAR BLVD
LEHIGH ACRES FL
33972-1106
US

V. Phone/Fax

Practice location:
  • Phone: 561-396-7530
  • Fax:
Mailing address:
  • Phone: 561-396-7530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-250646
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: