Healthcare Provider Details

I. General information

NPI: 1548006638
Provider Name (Legal Business Name): ASHLEY NICHOLE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15024 SW 58TH ST
MIAMI FL
33193-3005
US

IV. Provider business mailing address

15024 SW 58TH ST
MIAMI FL
33193-3005
US

V. Phone/Fax

Practice location:
  • Phone: 786-498-0610
  • Fax:
Mailing address:
  • Phone: 786-498-0610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-357771
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: