Healthcare Provider Details

I. General information

NPI: 1821917857
Provider Name (Legal Business Name): EDITH DE LA CARIDAD RODRIGUEZ GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 08/09/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6105 SW 129TH PL APT 1804
MIAMI FL
33183-5252
US

IV. Provider business mailing address

6105 SW 129TH PL APT 1804
MIAMI FL
33183-5252
US

V. Phone/Fax

Practice location:
  • Phone: 305-522-8962
  • Fax:
Mailing address:
  • Phone: 305-522-8962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-538327
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: