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General NPI Number Information
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NPI Number | 1801604608
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Entity Type | Individual
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Provider Name | LISANDRA MARTINEZ RODRIGUEZ
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Gender | Female
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Dates
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Enumeration Date | 12/26/2024
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 1457 LAKE CRYSTAL DR
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City | WEST PALM BEACH
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State | FL
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Zip | 33411-2017
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Country | US
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Telephone | 954-248-9115
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Fax |
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Provider Business Mailing Address
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Address Line | 5741 NW 101ST WAY
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City | CORAL SPRINGS
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State | FL
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Zip | 33076-2591
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Country | US
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Telephone | 954-248-9115
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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 | RBT-24-388536
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License Number State | FL
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