Healthcare Provider Details

I. General information

NPI: 1447899885
Provider Name (Legal Business Name): ROXANA LLANES RODRIGUEZ RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 W PARK DR # 12-3
MIAMI FL
33172-3980
US

IV. Provider business mailing address

465 W PARK DR # 12-3
MIAMI FL
33172-3980
US

V. Phone/Fax

Practice location:
  • Phone: 305-497-4928
  • Fax:
Mailing address:
  • Phone: 305-497-4928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-102293
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: