Provider Demographics
NPI:1033985312
Name:VENTO RODRIGUEZ, CARLOS D
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:D
Last Name:VENTO 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 1:1346 KIRK RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-4962
Mailing Address - Country:US
Mailing Address - Phone:561-644-2121
Mailing Address - Fax:
Practice Address - Street 1:1346 KIRK RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-4962
Practice Address - Country:US
Practice Address - Phone:561-644-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-310484106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician