Healthcare Provider Details

I. General information

NPI: 1457802027
Provider Name (Legal Business Name): YESSICA DELGADO RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11101 NW 19TH ST
PEMBROKE PINES FL
33026-2221
US

IV. Provider business mailing address

11101 NW 19TH ST
PEMBROKE PINES FL
33026-2221
US

V. Phone/Fax

Practice location:
  • Phone: 786-616-5578
  • Fax:
Mailing address:
  • Phone: 786-616-5578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberBCABA-0-18-9253
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA-1-20-42076
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: