Healthcare Provider Details

I. General information

NPI: 1982960886
Provider Name (Legal Business Name): YOANDRA RODRIGUEZ LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 NW 2ND ST APT 1
MIAMI FL
33125-5515
US

IV. Provider business mailing address

1429 NW 2ND ST APT 1
MIAMI FL
33125-5515
US

V. Phone/Fax

Practice location:
  • Phone: 786-663-0383
  • Fax:
Mailing address:
  • Phone: 786-663-0383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 65452
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: