Provider Demographics
NPI:1033798954
Name:RODRIGUEZ MIRANDA, ABDIEL E
Entity Type:Individual
Prefix:
First Name:ABDIEL
Middle Name:E
Last Name:RODRIGUEZ MIRANDA
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 1:1355 W 53RD ST APT 325
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3075
Mailing Address - Country:US
Mailing Address - Phone:786-216-4015
Mailing Address - Fax:
Practice Address - Street 1:1355 W 53RD ST APT 325
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3075
Practice Address - Country:US
Practice Address - Phone:786-216-4015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-154763106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty