=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982461836
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAYBET RODRIGUEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2024
-----------------------------------------------------
Last Update Date | 03/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8900 SW 107TH AVE STE 201
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176-1451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-401-6152
-----------------------------------------------------
Fax | 786-401-6155
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10820 SW 200TH DR APT 166
-----------------------------------------------------
City | CUTLER BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33157-7673
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-441-2456
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------