Provider Demographics
NPI:1003125097
Name:RODRIGUEZ, LILLIAM V
Entity Type:Individual
Prefix:MRS
First Name:LILLIAM
Middle Name:V
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12030 SW 129TH CT STE 209
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4584
Mailing Address - Country:US
Mailing Address - Phone:786-429-3619
Mailing Address - Fax:786-842-3529
Practice Address - Street 1:12030 SW 129TH CT STE 209
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4584
Practice Address - Country:US
Practice Address - Phone:786-429-3619
Practice Address - Fax:786-842-3529
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ5216235Z00000X
FLSA11495235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty