MEDICARE: ESTHER MARIE GORRIN 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		FL

General Provider Information

NPI Number	:	1629729967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTHER MARIE GORRIN RODRIGUEZ

Provider Business Mailing Address
First Line	:	1337 W 49TH PL APT 108
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-8157
Country	:	US
Telephone Number	:	786-647-3846
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 NE 155TH TER
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-5623
Country	:	US
Telephone Number	:	786-458-3836
Fax Number	:

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

Provider Enumeration Date	:	01/18/2022
Last Update Date	:	01/18/2022

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