Provider Demographics
NPI:1134647803
Name:RODRIGUEZ MONTE DE OCA, KEILA M (RBT)
Entity Type:Individual
Prefix:
First Name:KEILA
Middle Name:M
Last Name:RODRIGUEZ MONTE DE OCA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3865 W 9TH WAY
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-8219
Mailing Address - Country:US
Mailing Address - Phone:786-303-5668
Mailing Address - Fax:
Practice Address - Street 1:3865 W 9TH WAY
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-8219
Practice Address - Country:US
Practice Address - Phone:786-303-5668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2018-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty