Provider Demographics
NPI:1144797424
Name:RODRIGUEZ NUNEZ, BRAYAN DE JESUS
Entity Type:Individual
Prefix:
First Name:BRAYAN
Middle Name:DE JESUS
Last Name:RODRIGUEZ NUNEZ
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 1:25868 SW 137TH PATH
Mailing Address - Street 2:
Mailing Address - City:NARANJA
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8130
Mailing Address - Country:US
Mailing Address - Phone:786-234-1409
Mailing Address - Fax:
Practice Address - Street 1:25868 SW 137TH PATH
Practice Address - Street 2:
Practice Address - City:NARANJA
Practice Address - State:FL
Practice Address - Zip Code:33032-8130
Practice Address - Country:US
Practice Address - Phone:786-234-1409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty