Provider Demographics
NPI:1093297319
Name:RODRIGUEZ, ANA LUISA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:LUISA
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 1:809 E OAK ST. SUITE 105
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744
Mailing Address - Country:US
Mailing Address - Phone:407-483-9520
Mailing Address - Fax:
Practice Address - Street 1:2230 CASCADES BLVD UNIT 108
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-3479
Practice Address - Country:US
Practice Address - Phone:239-240-3090
Practice Address - Fax:407-483-9551
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst