MEDICARE: TAMIKA RODRIGUEZ

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		NY

General Provider Information

NPI Number	:	1346847928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMIKA RODRIGUEZ

Provider Business Mailing Address
First Line	:	4317 162ND ST APT 3
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-3107
Country	:	US
Telephone Number	:	347-420-7385
Fax Number	:

Provider Business Practice Location Address
First Line	:	4317 162ND ST APT 3
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-3107
Country	:	US
Telephone Number	:	347-420-7385
Fax Number	:

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

Provider Enumeration Date	:	10/06/2020
Last Update Date	:	10/06/2020

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Directions to “ TAMIKA RODRIGUEZ ” Practice Location

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