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General NPI Number Information
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NPI Number | 1790207280
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Entity Type | Individual
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Provider Name | ILENA GARCIA RODRIGUEZ
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Gender | Female
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Dates
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Enumeration Date | 07/17/2017
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 19800 SW 180TH AVE # LOTE504
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City | MIAMI
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State | FL
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Zip | 33187-2619
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Country | US
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Telephone | 55-049-3183
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Fax |
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Provider Business Mailing Address
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Address Line | 19800 SW 180TH AVE LOT 504
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City | MIAMI
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State | FL
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Zip | 33187-2617
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Country | US
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Telephone | 305-504-9318
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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 | 15-07869
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License Number State | FL
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