Healthcare Provider Details

I. General information

NPI: 1558123067
Provider Name (Legal Business Name): ARIANNE TEJERA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5203 SW 129TH AVE
MIAMI FL
33175-5335
US

IV. Provider business mailing address

5203 SW 129TH AVE
MIAMI FL
33175-5335
US

V. Phone/Fax

Practice location:
  • Phone: 786-818-1036
  • Fax:
Mailing address:
  • Phone: 786-818-1036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90208
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: