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General NPI Number Information
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NPI Number | 1164929329
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Entity Type | Individual
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Provider Name | YANELIS GUTIERREZ RODRIGUEZ RBT
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Gender | Female
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Dates
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Enumeration Date | 04/12/2018
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Last Update Date | 04/12/2018
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Provider Practice Location Address
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Address Line | 321 NW 78T TERRACE APT 104 APT104 B32
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City | PEMBROKE PINES
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State | FL
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Zip | 33024
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Country | US
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Telephone | 954-707-3046
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Fax |
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Provider Business Mailing Address
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Address Line | 5180 W ATLANTIC AVE STE 114
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City | DELRAY BEACH
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State | FL
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Zip | 33484-8103
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Country | US
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Telephone | 561-674-9996
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | FL
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