MEDICARE: KIMBERLY 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

General Provider Information

NPI Number	:	1598320400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY RODRIGUEZ

Provider Business Mailing Address
First Line	:	300 INTERNATIONAL PKWY STE 200
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5028
Country	:	US
Telephone Number	:	866-610-0580
Fax Number	:

Provider Business Practice Location Address
First Line	:	35435 ORANGE GROVE LN
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34788-2988
Country	:	US
Telephone Number	:	352-551-5715
Fax Number	:

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

Provider Enumeration Date	:	05/06/2019
Last Update Date	:	02/05/2026

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Directions to “ KIMBERLY RODRIGUEZ ” Practice Location

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