Healthcare Provider Details

I. General information

NPI: 1306620703
Provider Name (Legal Business Name): GEIDY BLANCO RODRIGUEZ I RBT-23-287274
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 16TH ST SW
LEHIGH ACRES FL
33976-3302
US

IV. Provider business mailing address

3909 16TH ST SW
LEHIGH ACRES FL
33976-3302
US

V. Phone/Fax

Practice location:
  • Phone: 786-972-7087
  • Fax:
Mailing address:
  • Phone: 786-972-7087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-287274
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: