Healthcare Provider Details

I. General information

NPI: 1174972665
Provider Name (Legal Business Name): MAIDELYS RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14335 SW 120TH ST SUITE #201
MIAMI FL
33186-7294
US

IV. Provider business mailing address

19840 LENAIRE DR
CUTLER BAY FL
33157-8525
US

V. Phone/Fax

Practice location:
  • Phone: 305-967-8074
  • Fax: 305-967-8302
Mailing address:
  • Phone: 305-989-5109
  • 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: