MEDICARE: MARILANDA C RODRIGUEZ N/A

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

General Provider Information

NPI Number	:	1326804972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILANDA C RODRIGUEZ N/A

Provider Business Mailing Address
First Line	:	3640 S FULTON AVE UNIT 1139
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30354-1757
Country	:	US
Telephone Number	:	484-663-1726
Fax Number	:

Provider Business Practice Location Address
First Line	:	3640 S FULTON AVE UNIT 1139
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30354-1757
Country	:	US
Telephone Number	:	484-663-1726
Fax Number	:

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

Provider Enumeration Date	:	02/22/2024
Last Update Date	:	02/22/2024

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