MEDICARE: YISELIS 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	20-120182	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	:	1629673710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YISELIS RODRIGUEZ

Provider Business Mailing Address
First Line	:	17321 NW 52ND AVE
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-4012
Country	:	US
Telephone Number	:	305-781-9898
Fax Number	:

Provider Business Practice Location Address
First Line	:	17321 NW 52ND AVE
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-4012
Country	:	US
Telephone Number	:	305-781-9898
Fax Number	:

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

Provider Enumeration Date	:	12/04/2020
Last Update Date	:	12/28/2020

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Directions to “ YISELIS RODRIGUEZ ” Practice Location

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