Healthcare Provider Details

I. General information

NPI: 1326861162
Provider Name (Legal Business Name): ROLANDO SOTO RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9380 SW 72ND ST STE B224
MIAMI FL
33173-5460
US

IV. Provider business mailing address

17772 NW 59TH AVE UNIT 101
HIALEAH FL
33015-5152
US

V. Phone/Fax

Practice location:
  • Phone: 786-353-2593
  • Fax: 786-558-4097
Mailing address:
  • Phone: 786-381-4293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-389565
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: