Healthcare Provider Details

I. General information

NPI: 1013507912
Provider Name (Legal Business Name): YADIRA RANGEL RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 NW 133RD AVE
MIAMI FL
33182-1601
US

IV. Provider business mailing address

631 NW 133RD AVE
MIAMI FL
33182-1601
US

V. Phone/Fax

Practice location:
  • Phone: 786-374-5114
  • Fax:
Mailing address:
  • Phone: 786-374-5114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90175
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-119487
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: