Healthcare Provider Details

I. General information

NPI: 1972474914
Provider Name (Legal Business Name): JAVIER ALEJANDRO SANTIESTEBAN RODRIGUEZ
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SW 107TH AVE STE 205
MIAMI FL
33174-3602
US

IV. Provider business mailing address

45 E 11TH ST APT 6
HIALEAH FL
33010-4114
US

V. Phone/Fax

Practice location:
  • Phone: 305-209-0038
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: