Healthcare Provider Details

I. General information

NPI: 1639033699
Provider Name (Legal Business Name): RACIEL RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15801 NW 52ND AVE APT 307
MIAMI LAKES FL
33014-6215
US

IV. Provider business mailing address

15801 NW 52ND AVE APT 307
MIAMI LAKES FL
33014-6215
US

V. Phone/Fax

Practice location:
  • Phone: 786-901-4462
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-475849
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: