Healthcare Provider Details

I. General information

NPI: 1487578423
Provider Name (Legal Business Name): DIEGO RAMON RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7975 NW 154TH ST STE 230
MIAMI LAKES FL
33016-5849
US

IV. Provider business mailing address

12746 NW 99TH CT
HIALEAH GARDENS FL
33018-7412
US

V. Phone/Fax

Practice location:
  • Phone: 305-874-7245
  • Fax:
Mailing address:
  • Phone: 305-874-7245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: