Healthcare Provider Details

I. General information

NPI: 1326654088
Provider Name (Legal Business Name): AMANDA GUZMAN RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8665 SW 152ND AVE APT 134
MIAMI FL
33193-4126
US

IV. Provider business mailing address

8665 SW 152ND AVE APT 134
MIAMI FL
33193-4126
US

V. Phone/Fax

Practice location:
  • Phone: 786-720-5180
  • Fax:
Mailing address:
  • Phone: 786-720-5180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-127159
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: