Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-21-152148 | FL |
NPI | 1003407842 |
---|---|
Provider Name | Amanda Rodriguez |
First Address | Loxahatchee, FL 33470-3204 |
Second Address | Loxahatchee, FL 33470-3204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2021 |
Last Update Date | 02/02/2021 |