Healthcare Provider Details

I. General information

NPI: 1922668946
Provider Name (Legal Business Name): MS. LISBETY PEREZ RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16125 NW 47TH AVE
MIAMI GARDENS FL
33054-6071
US

IV. Provider business mailing address

16229 NW 47TH AVE
MIAMI GARDENS FL
33054-6070
US

V. Phone/Fax

Practice location:
  • Phone: 786-458-5130
  • Fax:
Mailing address:
  • Phone: 786-458-5130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA-21-47081
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT1989992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: