Provider Demographics
NPI:1003332362
Name:RODRIGUEZ, ADRIAN CAMILO
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:CAMILO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5585 W 26TH AVE APT 115
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4076
Mailing Address - Country:US
Mailing Address - Phone:786-328-9866
Mailing Address - Fax:
Practice Address - Street 1:5585 W 26TH AVE APT 115
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-4076
Practice Address - Country:US
Practice Address - Phone:786-328-9866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician