Provider Demographics
NPI:1073960712
Name:RODIRGUEZ, DOLORES (RBT 1507820)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:
Last Name:RODIRGUEZ
Suffix:
Gender:F
Credentials:RBT 1507820
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6791 SW 80TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4528
Mailing Address - Country:US
Mailing Address - Phone:786-291-6003
Mailing Address - Fax:
Practice Address - Street 1:6791 SW 80TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4528
Practice Address - Country:US
Practice Address - Phone:786-291-6003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT 1507820103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT 1507820OtherBACB