MEDICARE: JENNIFER 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1376844977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER RODRIGUEZ

Provider Business Mailing Address
First Line	:	15501 BRUCE B DOWNS BLVD
Second Line	:	APT. 4318
City	:	TAMPA
State	:	FL
Zip	:	33647-1374
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15501 BRUCE B DOWNS BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-1374
Country	:	US
Telephone Number	:	813-384-8087
Fax Number	:

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

Provider Enumeration Date	:	11/12/2010
Last Update Date	:	11/12/2010

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