Healthcare Provider Details

I. General information

NPI: 1326748708
Provider Name (Legal Business Name): YAIMA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4435 WILLOW POND RD APT D
WEST PALM BEACH FL
33417-8289
US

IV. Provider business mailing address

4435 WILLOW POND RD APT D
WEST PALM BEACH FL
33417-8289
US

V. Phone/Fax

Practice location:
  • Phone: 561-485-7767
  • Fax:
Mailing address:
  • Phone: 561-485-7767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23259113
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: