Healthcare Provider Details

I. General information

NPI: 1124840293
Provider Name (Legal Business Name): LORENA RODRIGUEZ CARDOSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9415 SW 72ND ST STE 101
MIAMI FL
33173-5493
US

IV. Provider business mailing address

2100 SW 15TH ST
MIAMI FL
33145-1314
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-6448
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-24-15668
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89611
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-311131
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: