Provider Demographics
NPI:1144871625
Name:RODRIGUEZ, SANDRA (BCABA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 NW 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3119
Mailing Address - Country:US
Mailing Address - Phone:786-439-6961
Mailing Address - Fax:
Practice Address - Street 1:617 NW 58TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3119
Practice Address - Country:US
Practice Address - Phone:786-439-6961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst