Healthcare Provider Details

I. General information

NPI: 1194646158
Provider Name (Legal Business Name): INGRID GRACE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9415 SW 72ND ST STE 131
MIAMI FL
33173-5492
US

IV. Provider business mailing address

9415 SW 72ND ST STE 131
MIAMI FL
33173-5492
US

V. Phone/Fax

Practice location:
  • Phone: 786-953-8389
  • Fax:
Mailing address:
  • Phone: 786-953-8389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ13454
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: