Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003304999 |
---|---|
Provider Name | Nicole Rodriguez |
First Address | Miami, FL 33165-6257 |
Second Address | Miami, FL 33165-6257 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2018 |
Last Update Date | 25/04/2018 |