Healthcare Provider Details

I. General information

NPI: 1548826381
Provider Name (Legal Business Name): YOSLEIDY RODRIGUEZ GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 TRAVIS RD
WEST PALM BEACH FL
33406-5205
US

IV. Provider business mailing address

1900 TRAVIS RD
WEST PALM BEACH FL
33406-5205
US

V. Phone/Fax

Practice location:
  • Phone: 561-628-5710
  • Fax:
Mailing address:
  • Phone: 561-628-5710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-20-11563
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-77995
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: