MEDICARE: LETICIA RODRIGUEZ-GALLO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	20-118990	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144736380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LETICIA RODRIGUEZ-GALLO

Provider Business Mailing Address
First Line	:	20030 NW 63RD AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-2169
Country	:	US
Telephone Number	:	786-319-3100
Fax Number	:

Provider Business Practice Location Address
First Line	:	20030 NW 63RD AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-2169
Country	:	US
Telephone Number	:	786-319-3100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2017
Last Update Date	:	05/13/2025

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Directions to “ LETICIA RODRIGUEZ-GALLO ” Practice Location

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