Healthcare Provider Details

I. General information

NPI: 1235976853
Provider Name (Legal Business Name): CARMEN ROSA RODRIGUEZ RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 GOLDEN GATE PKWY
NAPLES FL
34116-7524
US

IV. Provider business mailing address

4179 GOLDEN GATE PKWY
NAPLES FL
34116-6521
US

V. Phone/Fax

Practice location:
  • Phone: 239-778-8455
  • Fax:
Mailing address:
  • Phone: 239-427-5193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number24-356188
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: